| Objectives: To evaluate the diagnosis methods and treatment strategy in spontaneous discitis in adults.Method: Twenty consecutive adult patients with spontaneous discitis were studied from March 2005 to December 2013. The average age of these patients was 56 years old. The clinical characteristics of all patients had severe low back pain and low-grade fever. None of these patients had o spinal injection r previous spinal surgery. 8 of 20 cases had concurrent diabetic, urinary tract infection, a history of stroke, et al. 10 of 20 cases were misdiagnosed with spinal tuberculosis in other hospitals. All patients had a rise in the erythrocyte sedimentation rate(ESR). Local signal abnormiries were showed in MRI. All cases were treated with intravenous antibiotics first for a mean duration. 12 of 20 cases underwent debridement, intervertebral grafting and internal fixation.Results: All patients experienced significant relief of symptoms. The histological exam ination of specmen, both surgically and non-surgically, through spinal injection, revealed the inflammation in all patients. One revealed the injection of Staphylococcus aureus. All patients were followed-up for from 12 to 116 months, with a mean time of 41 months. 8 cases with conservative treatment were recovered gradually. 2 cases suffered slight back pain. 1 cases with surgical treatment were postoperative recurrence after 4 months. After 6 weeks’ conservative treatment, the patient was recovered. No implant breaking or loosening of screw occurred in the latest follow-up.Conclusion: Early diagnosis of spontaneous discitis in adults is often difficult due to its various clinical presentations. ESR and MRI have diagnostic sensitivity. Once diagnosis of spontaneous discitis was diagnosed, high doses of intravenous antibiotics should be used early. When conservative treatment is invalid, surgical treatment should be used and those patient should undergo debridement to control injection and relieve symptoms. |
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