Sato Tomoya, Yamada Katsuhisa, Yasui Keigo, Okumura Junichiro, Kanayama Masahiro, Hyakkan Ryota, Hasebe Hiroyuki, Hasegawa Yuichi, Nakayama Hiroshi, Endo Tsutomu, Ukeba Daisuke, Tachi Hiroyuki, Chubachi Toshiya, Sudo Hideki, Takahata Masahiko, Ito Manabu, Iwasaki Norimasa
Department of Orthopaedic Surgery, Hokkaido University Hospital, Hokkaido, Japan.
Hokkaido Spine Study Group, Hokkaido, Japan.
Spine Surg Relat Res. 2025 Apr 5;9(4):485-491. doi: 10.22603/ssrr.2024-0320. eCollection 2025 Jul 27.
Delayed diagnosis and therapy initiation for pyogenic spondylitis can have severe and fatal consequences. Early diagnosis and intervention are crucial in the treatment of pyogenic spondylitis. This multicenter cross-sectional study with prospective case series aimed to identify factors influencing the time from symptom onset to the diagnosis of pyogenic spondylitis.
Patients hospitalized with pyogenic spondylitis between 2019 and 2023 were included. Patients were classified into 2 groups: the delayed diagnosis group (>30 days from the onset of initial symptoms to the diagnosis of pyogenic spondylitis) and the early diagnosis group (within 29 days). Risk factors for delayed diagnosis were analyzed.
A total of 74 patients (42 men and 32 women; mean age: 70.2 years) from 5 institutions were included. Univariate analysis of risk factors for delayed diagnosis revealed that the significant risk factors included advanced age (p=0.03), low white blood cell count (p<0.01), low C-reactive protein level (p<0.05), and semi-rigid spinal level, based on the spinal instability neoplastic score classification (p=0.05). Multivariate analysis for delayed diagnosis showed that the location at the semi-rigid spinal level was a significant risk factor (p=0.02). The vertebral bone destruction rate and abscess cavity index in the delayed diagnosis group were significantly higher than those in the early diagnosis group (p<0.01 and p<0.01, respectively).
Significant risk factors for delayed diagnosis of pyogenic spondylodiscitis include infection at the semi-rigid thoracic spinal level. Early diagnosis of spondylodiscitis is crucial because delayed diagnosis can lead to progressive bone destruction and the formation of large abscesses. Increased awareness of thoracic spinal infections, which can easily delay diagnosis, could help in the early diagnosis and treatment of pyogenic spondylodiscitis.
化脓性脊柱炎的诊断延迟和治疗启动延迟可能会产生严重和致命的后果。早期诊断和干预对于化脓性脊柱炎的治疗至关重要。这项多中心横断面研究及前瞻性病例系列旨在确定影响从症状出现到化脓性脊柱炎诊断时间的因素。
纳入2019年至2023年期间因化脓性脊柱炎住院的患者。患者分为两组：诊断延迟组（从初始症状出现到化脓性脊柱炎诊断超过30天）和早期诊断组（在29天内）。分析诊断延迟的危险因素。
共纳入来自5家机构的74例患者（42例男性和32例女性；平均年龄：70.2岁）。诊断延迟危险因素的单因素分析显示，显著危险因素包括高龄（p=0.03）、白细胞计数低（p<0.01）、C反应蛋白水平低（p<0.05）以及基于脊柱不稳定肿瘤评分分类的半刚性脊柱节段（p=0.05）。诊断延迟的多因素分析显示，半刚性脊柱节段的位置是一个显著危险因素（p=0.02）。诊断延迟组的椎体骨破坏率和脓肿腔指数显著高于早期诊断组（分别为p<0.01和p<0.01）。
化脓性脊椎间盘炎诊断延迟的显著危险因素包括半刚性胸段脊柱感染。脊椎间盘炎的早期诊断至关重要，因为诊断延迟可导致进行性骨破坏和大脓肿形成。提高对易导致诊断延迟的胸段脊柱感染的认识，有助于化脓性脊椎间盘炎的早期诊断和治疗。
