Tang Kai, Zhang Xi, Li Yongchao, Lan Tinglong, Fan Jun, Li Yuan, Wang Heng, Kang Wanli, Qin Shibing, Dong Weijie
Department of Orthopedics, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
Department of Office of Disease Control and Prevention, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
World Neurosurg. 2025 May;197:123904. doi: 10.1016/j.wneu.2025.123904. Epub 2025 Mar 17.
Previous studies have found that the positive rate of bacterial culture after percutaneous needle biopsy in patients with suspected pyogenic spondylodiscitis is influenced by a number of factors. At the same time, the choice of puncture site in percutaneous biopsy has been controversial. The objective of this study is to explore the factors influencing the positive rate of bacterial culture after percutaneous biopsy in patients with pyogenic spondylodiscitis.
The medical records of 186 patients with suspected spinal infection who underwent C-type arm-guided percutaneous biopsy in Beijing Chest Hospital Affiliated to Capital Medical University from January 2023 to December 2023 were retrospectively analyzed. According to inclusion and exclusion criteria, a total of 116 patients with suspected pyogenic spondylodiscitis were included. The positive rate of bacterial culture was calculated, and the effects of age, gender, course of disease, preoperative fever, preoperative antibiotic use, preoperative white blood cell count, C-reactive protein (CRP), erythrocyte sedimentation rate, and puncture site on the positive rate of culture were discussed. Logistic regression analysis was used to identify the relevant factors affecting the positive rate of culture.
Among the 116 patients, 63 were males and 53 were females. Age ranged from 13 to 87 years, with a median age of 59.5 years. The results of bacterial culture in 42 patients were positive, with a positive rate of 36.2% (42/116), including Staphylococcus aureus in 12 cases, streptococcus in 5 cases, Brucella in 5 cases, Escherichia coli in 4 cases, Staphylococcus epidermidis in 3 cases, Pseudomonas aeruginosa in 2 cases, Enterococcus faecalis in 2 cases, anaerobic bacteria in 2 cases, and other bacteria in 7 cases. The positive rate of bacterial culture was 22.6% (14/62) in patients with vertebral body puncture and 51.9% (28/54) in patients with intervertebral disc puncture, and there was a significant difference between the 2 groups (P = 0.001). Logistic regression analysis showed that the course of disease, the increase of CRP before puncture, and the site of puncture were the factors influencing the positive rate of culture.
The course of disease, the elevation of CRP before puncture, and the site of puncture were the factors influencing the positive rate of bacterial culture in percutaneous biopsy of pyogenic spondylodiscitis patients. The positive rate of obtaining intervertebral disc in percutaneous puncture was significantly higher than that of vertebral body, suggesting that intervertebral disc is a more critical puncture site.
既往研究发现，疑似化脓性脊椎间盘炎患者经皮穿刺活检后细菌培养的阳性率受多种因素影响。同时，经皮活检穿刺部位的选择一直存在争议。本研究的目的是探讨影响化脓性脊椎间盘炎患者经皮活检后细菌培养阳性率的因素。
回顾性分析2023年1月至2023年12月在首都医科大学附属北京胸科医院接受C型臂引导下经皮穿刺活检的186例疑似脊柱感染患者的病历资料。根据纳入和排除标准，共纳入116例疑似化脓性脊椎间盘炎患者。计算细菌培养阳性率，探讨年龄、性别、病程、术前发热、术前使用抗生素、术前白细胞计数、C反应蛋白（CRP）、红细胞沉降率及穿刺部位对培养阳性率的影响。采用Logistic回归分析确定影响培养阳性率的相关因素。
116例患者中，男性63例，女性53例。年龄13～87岁，中位年龄59.5岁。42例患者细菌培养结果为阳性，阳性率为36.2%（42/116），其中金黄色葡萄球菌12例，链球菌5例，布鲁氏菌5例，大肠埃希菌4例，表皮葡萄球菌3例，铜绿假单胞菌2例，粪肠球菌2例，厌氧菌2例，其他细菌7例。椎体穿刺患者细菌培养阳性率为22.6%（14/62），椎间盘穿刺患者细菌培养阳性率为51.9%（28/54），两组间差异有统计学意义（P = 0.001）。Logistic回归分析显示，病程、穿刺前CRP升高及穿刺部位是影响培养阳性率的因素。
病程、穿刺前CRP升高及穿刺部位是影响化脓性脊椎间盘炎患者经皮活检细菌培养阳性率的因素。经皮穿刺获取椎间盘的阳性率明显高于椎体，提示椎间盘是更关键的穿刺部位。
