关键词: 脊柱炎, 葡萄球菌, 金黄色, 结核, 脊柱, 诊断, 鉴别, 外科手术, 脊柱融合术, 治疗结果

Abstract:

Objective To investigate the clinical diagnosis of pyogenic spondylitis caused by Staphylococcus aureus, the differential diagnosis with spinal tuberculosis, the operative effect and the related risk factors.Methods We analyzed retrospectively clinical data in 14 cases with pyogenic spondylitis caused by Staphylococcus aureus, which was misdiagnosed as spinal tuberculosis in other hospital, from January 2004 to December 2016. There were 9 males and 5 females, disease involved cervical vertebrae in 2 cases, thoracic vertebrae in 5 cases and lumbar vertebrae in 7 cases. According to the neurological function grade in the American Spinal Injury Association (ASIA), there were grade B in 1 case, grade C in 2 cases, grade D in 5 cases and grade E in 6 cases. Of 14 cases, all were complicated with one or more other diseases including diabetes mellitus in 8 cases, chronic nephritis in 2 cases, ankylosing spondylitis in 2 cases, liver cirrhosis in 1 case, hypertension in 6 cases and severe pulmonary infection in 5 cases. Surgical effect and related risk factors were evaluated with some characteristics such as postoperative complication, visual analogue scale(VAS) before and after operation, postoperative bone graft fusion rate and the changes of postoperative Cobb angle and so on.Results All the cases were misdiagnosed as spinal tuberculosis before operation, and were diagnosed as pyogenic spondylitis caused by Staphylococcus aureus with indications of preoperative pain and paraplegia. Surgical methods were performed with simple posterior internal fixation and debridement in 9 cases, posterior internal fixation and anterior debridement in 3 cases, anterior internal fixation and debridement for cervical spondylosis in 2 cases. All cases were followed up average 22 months ranged from 12 to 36 months. All operations were completed successfully in 14 cases with average operative time (187.8±67.5) min and average intraoperative bleeding volume (460.5±86.4) ml. Postoperative complications were occurred in 5 cases including delayed incision healing in 3 cases, transient septic toxic shock after operation in 1 case and postoperative bacteremia in 1 case. Bone graft fusion was in all case at the last follow-up. Of all cases at the last follow-up, the neurological function grade were improved significantly including grade D in 3 cases and grade E in 11 cases. VAS were improved significantly after operation ranged from (7.4±1.4) scores to (2.3±1.1) scores with significant difference(t=13.60,P=0.000).Conclusion Pyogenic spondylitis caused by Staphylococcus aureus is easily misdia-gnosed as spinal tuberculosis before operation. Operative risks include incision nonunion and bacteremia after operation. Operative effect can be satisfactory when preoperative diagnosis, operative indication and management of related complications is accurate and timely.

Key words: Spondylitis, Staphylococcus aureus, Tuberculosis, spinal, Diagnosis, differential, Surgical procedures, operative, Spinal fusion, Treatment outcome