Beguiristáin J L, Villas C, Garbayo A
Dpto. de Cirugía Ortopédica y Traumatología, Universitaria Facultad de Medicina, Universidad de Navarra, Pamplona.
Rev Med Univ Navarra. 1987 Jul-Sep;31(3):149-52, 155-6, 159-61.
Non tuberculous spondylodiscitis of the rachis is an uncommon entity that affects boys and male adults with greater frequency. The zone with higher incidence of affection is the lumbar region. Usually the causal germ travels through the hematogenous via from an extrarachidial infectious area. Clinical manifestations begin with an acute segmentary rachialgia and paravertebral muscular contracture while presenting fever. In special cases of little boys or when having radiated pain, the presenting form could be confusing. There is always a vertebral rigidity when performing the physical exam and an increase of the globular sedimentation rate. A septic leukocytal formula is not always present. Between the onset of symptoms and the appearance of radiologic alterations (decrease in the height of the disc, erosion and vertebral destruction, reactive bone neo-formation) there is a variable two to eight weeks latency period. Scintigraphy with Tc99 and Ga67 and CAT scan are very important when facing definite diagnosis. To be able to reach a bacteriological diagnosis, we employ puncture-aspiration of the disc. The isolated germ in most cases is staphylococcus aureus. The most complex differential diagnosis is with tuberculous spondylodiscitis. The evolution is favorable if the treatment is initiated early and if it is adequate (antibiotic therapy and immobilization). If this is not done, recurrences and chronicity of the infection can occur, as well as orthopaedic (Kyphosis) and neurological complications.
非结核性脊柱椎间盘炎是一种罕见的疾病，更常见于男孩和成年男性。受累发生率较高的部位是腰椎区域。通常致病病菌通过血行途径从脊柱外感染区域传播。临床表现始于急性节段性脊柱疼痛和椎旁肌肉挛缩，同时伴有发热。在小男孩的特殊情况下或出现放射性疼痛时，表现形式可能令人困惑。体格检查时总会出现脊柱僵硬，血沉加快。并不总是出现感染性白细胞计数公式。在症状出现与放射学改变（椎间盘高度降低、侵蚀和椎体破坏、反应性骨新形成）出现之间，有两到八周不等的潜伏期。当面临明确诊断时，Tc99和Ga67闪烁扫描以及计算机断层扫描非常重要。为了能够做出细菌学诊断，我们采用椎间盘穿刺抽吸术。大多数情况下分离出的病菌是金黄色葡萄球菌。最复杂的鉴别诊断是与结核性脊柱椎间盘炎。如果早期开始治疗且治疗得当（抗生素治疗和固定），病情发展是有利的。如果不这样做，可能会发生感染复发和慢性化，以及骨科（脊柱后凸）和神经并发症。
