Abstract:

Objective To analyze the clinical characteristics of the patients with primary non-specific spinal infection and spinal tuberculosis (TB). Methods A retrospective analysis was conducted in 197 patients with spinal infectious diseases who were admitted in the Department of Orthopedics of Hebei Provincial Chest Hospital from January 2014 to December 2015. According to the type of pathogenic bacteria, those enrolled patients were divided into two groups: one was the primary non-specific spinal infection group(non-specific infection group, 21 cases (10.7%))and the other was spinal TB group (TB group, 176 cases (89.3%)). The clinical materials, laboratory examination results and imaging manifestations of the patients in the two groups were compared, and the results of pathogeny detection and treatment outcome of the patients in the non-specific infection group were summarized. Results The age (62.0 (49.5, 66.5) years), mean peak value of body temperature in fever ((38.8±0.9) ℃), white blood cells (WBC) count (8.4 (6.9, 9.4)×10 ⁹/L), erythrocyte sedimentation rate (ESR) (76.0 (61.5, 103.5) mm/1 h) and C-reactive protein (CRP) (68.0 (56.9, 79.0) mg/L) of the patients in the non-specific infection group were significantly higher than those of the patients in the TB group respectively (38.5 (24.0, 54.5) years, (37.8±0.6) ℃, 6.5 (5.2, 7.4)×10 ⁹/L, 40.0 (30.0,50.0) mm/1 h, 24.0 (18.0, 28.0) mg/L), and those differences were statistically significant (U=914.000,P=0.000;t=4.320,P=0.000;U=1005.000,P=0.001;U=307.500,P=0.000;U=100.000,P=0.000). However, the onset time (1.5 (1.0, 2.0) months) of the patients in the non-specific infection group was significantly shorter than that of the patients in the TB group (6.0 (4.0, 7.8) months; U=120.000, P=0.000). The incidences of bone bridge formation showed in X-ray plain (38.1% (8/21)), sequestrum (38.1% (8/21)) and paraspinal abscess (19.0% (4/21)) showed in CT imaging of the patients in the non-specific infection group were statistically significantly different compared with those of the patients in the TB group (9.7% (17/176), 72.2% (127/176), 52.3% (92/176), χ ²=11.246, 10.094, 8.290 and P=0.000, 0.001, 0.004). In the non-specific infection group, the postoperative focus was uncured in 4 cases. Eventually they were cured by adjusting antibiotics treatment and performing debridement combined with continuous catheter irrigation and drainage. There was no recurrence during the follow-up. Conclusion Compared with the patients with spinal TB, the patients with non-specific infection were older, had higher peak value of body temperature, WBC count, ESR and CRP, but their onset time was shorter and they were more likely to have bone bridge and sequestrum which showed in imaging manifestations. By the treatment of drug and surgery, the patients could be completely cured without recurrence.

Key words: Tuberculosis,spinal, Bone diseases,infectious, Disease attributes, Diagnosis,differential