| Objective To investigate the differences in clinical characteristics between pyogenic spondylodiscitis(PS),tuberculous spondylodiscitis(TS),and brucellar spondylodiscitis(BS),and to analyze the main points of diagnosis and differential diagnosis.Methods A retrospective analysis of the clinical data of 143 patients with spinal infection diagnosed and treated in the Department of Spine Orthopedics,General Hospital of Ningxia Medical University from January 2016 to December 2020,including 33 cases of PS,58 cases of TS,and 52 cases of BS.The clinical data of the three groups were compared and analyzed,including general conditions,clinical manifestations,laboratory tests,imaging examinations,and the bacteriological characteristics of PS were analyzed.Results The average age of PS group was(59.67±12.76)years,TB group(54.11±14.14)years,and BS group(52.43±11.73)years.There was a statistically significant difference in age between the three groups(P<0.05).PS combined with diabetes mellitus in 9 cases(27.3%),trauma in 4 cases(12.1%),5 cases(15.2%)with a history of lumbar puncture before the onset,the difference was statistically significant compared with the other two groups(P<0.05).There were 10 cases(30.3%)with clinical symptoms less than 1 month in PS group,17 cases(51.5%)lasted from 1 to 3 months,and 6 cases(18.2%)more than 3 months;there were 8 cases(13.8%)with clinical symptoms less than 1 month in TS group,21 cases(36.2%)lasted from 1 to 3months,and 29 cases(50.0%)more than 3 months;there were 20 cases(38.5%)with clinical symptoms less than 1 month in BS group,17 cases(32.7%)lasted from 1 to 3 months,and 15cases(28.8%)more than 3 months.The difference in the duration of the clinical symptoms between the three groups was statistically significant(P<0.05).There were 22 cases(66.7%)in PS group with fever,17 cases(29.3%)in TB group,and 19 cases(36.5%)in BS group.It’s statistically significant difference between the three groups(P<0.05).The visual analogue scale(VAS)was(5.12±0.87)points of PS,(3.47±1.37)points of TS,and(5.56±1.43)points of BS,that was statistically significant difference among the three groups(P<0.05).PS group white blood cell count(WBC)was 10.24×10~9/L(7.02×10~9-13.86×10~9/L),erythrocyte sedimentation rate(ESR)was 67 mm/h(49-86 mm/h),C-reactive protein(CRP)was 65 mg/L(29.4-120 mg/L);TS group WBC was 6.47×10~9/L(5.40×10~9-8.32×10~9/L),ESR was 36 mm/h(16-57 mm/h),CRP was 25.3 mg/L(8.26-41.5 mg/L);BS group WBC was 6.91×10~9/L(5.41×10~9-8.90×10~9/L),ESR was 51mm/h(31.5-72.75 mm/h),CRP was 36.4 mg/L(8.54-59.08mg/L),and the differences in WBC,ESR and CRP among the three groups were statistically significant(P<0.05).There was no statistically significant difference in the location of the lesion and the formation of epidural abscess between the three groups.There were significant differences in the formation of paravertebral abscess and psoas muscle abscess among the three groups(P<0.05).In PS group,17 cases(51.5%)were generally positive for bacterial culture,of which 47.1%of Gram-positive bacteria,Staphylococcus aureus was the most common bacteria;and 35.3%of Gram-negative bacteria,of which Escherichia coli was the most common bacteria.Conclusion Compared with TS and BS,PS has characteristic differences and can be differentiated.PS is more common in middle-aged and elderly people.Old age,diabetes mellitus are predisposing factors.lumbar puncture treatment history or history of trauma are predisposing factors,acute or subacute;pain is more severe,fever is more common,generally moderate to high fever.WBC,ESR,CRP of PS are higher than TS,BS,and it is of value to differentiate.PS is most common in the lumbar spine,followed by the thoracic spine.Paravertebral abscess and psoas muscle abscess are less common than TS.The most common pathogenic bacteria of PS were Staphylococcus aureus and Escherichia coli. |
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