Caroit M, de Perignon M, Levernieux J, Debeyre J, de Sèze S
Rev Rhum Mal Osteoartic. 1975 Mar;42(3):153-9.
The authors tried to determine the ways in which vertebral puncture biopsy and the direct surgical approach can helpin the etiological diagnosis of spondylodiscitis, when the clinical radiological, and laboratory examination leave the clinician in doubt. Out of 28 vertebral puncture biopsies, proof of tuberculosis was obtained in 4 cases, and proof of a non-tuberculous cause was obtained in 1 case as a result of isolating the responsible organism. Thirty-eight cases were submitted to the direct surgical approach. When the indication for surgery was solely in order to investigate the etiology, proof of tuberculosis was obtained in half of the cases, and only exceptionally was a non-tuberculous organism discovered. In almost half the cases, the histological characteristics were non-specific and no organisms were detected. Most of these latter cases were, in fact, non-tuberculous spondylodiscitis, although subsequently some of them exhibited evidence of a tuberculous character. In the present state of knowledge, it seems that, in cases of clearly non-tuberculous spondylodiscitis, the direct surgical approach is not justified if the objective is solely to isolate the organism, so that its sensitivity to antibiotics can be tested. The following reasons are given for this conclusion : the direct surgical approach only rarely leads to isolation of the causal organism; although treatment based on knowledge of antibiotic sensitivity may help to restrict evolution of the disease, it does not reduce significantly, or only rarely, the permanent partial incapacity. If the results published by Seignon and Gougeon are confirmed, early needle puncture of the diskovertebral centre of the disease should be practised more widely.
当临床、放射学及实验室检查结果仍令临床医生存疑时，作者试图确定经椎骨穿刺活检及直接手术入路在脊椎椎间盘炎病因诊断中的作用。28例经椎骨穿刺活检中，4例确诊为结核病，1例因分离出致病微生物确诊为非结核病因。38例采用直接手术入路。当手术指征仅为查明病因时，半数病例确诊为结核病，仅极个别情况下发现非结核微生物。近半数病例组织学特征不具特异性，未检测到微生物。事实上，这些病例多数为非结核性脊椎椎间盘炎，尽管其中一些病例后来出现了结核特征的证据。就目前的认知状况而言，对于明确的非结核性脊椎椎间盘炎病例，如果目的仅为分离微生物以便检测其对抗生素的敏感性，那么直接手术入路似乎并无必要。得出这一结论的理由如下：直接手术入路很少能分离出致病微生物；尽管基于抗生素敏感性知识的治疗可能有助于控制疾病进展，但并不能显著降低或仅极少能降低永久性部分失能的发生率。如果Seignon和Gougeon发表的结果得到证实，那么应更广泛地开展对病椎盘中心的早期穿刺。
