成人自发性腰椎间盘炎

Spontaneous lumbar discitis in adults

目的:探讨成人自发性腰椎间盘炎的临床特征及治疗策略.方法:自1997年7月～2003年3月收治成人自发性腰椎间盘炎15例,平均年龄53岁.15例中7例分别合并糖尿病、慢性牙周感染、慢性盆腔炎.全组血沉均升高(48～118mm/h).MRI检查可见局部信号改变,采用静脉抗生素治疗至少1个月,同时卧床,使用止痛剂.3例行前路病灶清除术(2例因误诊为腰椎肿瘤或结核,1例因椎旁胀肿形成),术后腰痛立即缓解.结果:平均随访26个月,患者腰部疼痛均无复发,X线片显示脊柱稳定.结论:成人自发性腰椎间盘炎疾病潜伏期较长,临床表现非特异,早期诊断较困难,血沉和MRI是较敏感的诊断指标.治疗以早期应用大剂量抗生素,配合制动及对症处理等非手术疗法为主.

Objective:To evaluate the clinical characteristics and the treatment strategy in spontaneous lumbar discitis in adults.Method:Fifteen consecutive adult patients with spontaneous lumbar discitis were studied from July1997to March2003.The average age of patients was53years old.7of15cases had concurrent diabetic,pericoronitis and chronic infection in the pelvic cavity respectively.All patients had a risen erythrocyte sedimentation rate(range,48～118mm/h).MRI showed local signal abnormities.All of the patients had to stay in bed,treated with intravenous antibiotics for a mean duration of at least one month,and the antalgic was necessary.3cases underwent anterior debridement.Result:At an average follow-up of26months,all patients were symptom-free,X-ray films demonstrated that the lumbar spine in this series was stable.Conclusion:Early diagnosis of adult spontaneous lumbar discitis is often difficult because of the long latency period and various clinical presentations.MRI and ESR has diagnostic sensitivity.A good clinical outcome is achieved with non-surgical treatment including antibiotic administration,immoblization and antalgic.