Diagnosis and treatment of primary lumbar discitis

English Keywords:Lumbar vertebra  Disc space infection  Diagnosis  Treatment

English Abstract:

  【Abstract】 Objective：To investigate the diagnosis and treatment of primary Lumbar discitis（PLD）.Method：Clinical data of 10 PLD cases treated from Aug. 2004 to Dec. 2008 were reviewed retrospectively.There were 6 males and 4 females with the mean age of 52 years（range，26-79 years）.At admission，three cases had slight back pain，2 cases had back pain and severe leg pain，only 5 cases had severe back pain.All cases had fever range from 37.8℃ to 40.0℃（average 38.3℃）.Prior to discitis，4 cases had diabetes mellitus，2 had invasive exam of prostate，2 had urinary tract infection.Leucocyte count showed normal in 6 cases，increased in 4 cases.ESR and CRP increased in all cases.Preoperative bacterial cultures showed positive in 2 cases，one bacillus coli of blood and one staphylococcus aureus of urine.Involved level was L2/3 combined L3/4 in 1 case，L4/5 in 5 cases，L5/S1 in 4 cases.CT scan showed end plate irregular destruction of vicinity vertebrae in 9 cases（L5 pedical erosion in 1 case）.MRI exam showed involved level uneven low signal changes in T1 phase，and well-distributed high signal changes in T2 phase in 9 cases，abnormal signal of involved disc accompanied by vertebral canal tumor in 1 case.Five cases diagnosed as PLD were treated with bed rest absolutely and antibiotic administration，of these，3 young patients healed without operation after conservative treatment，2 cases underwent surgery due to irresponsibility to conservative treatment.While for the other 5 cases，3 were diagnosed as tuberculosis and 2 as tumor，received operation.Seven patients experiencing surgery had pathologic test and antibiotic treatment.Result：Pathologic etiology was infection in 7 cases undergoing surgery.All cases were followed up from 8 to 24 months（average，18 months）.Three patients receiving conservative treatment had back pain relieved after 1 week treatment，ESR and CRP returned to normal after 6 weeks.Lumbar X-ray showed no unstability at 12 month.In seven patients experiencing surgery，all had back pain relieved or even disappeared，ESR and CRP returned to normal at 2 to 5 days，2 weeks and 2 to 3 weeks post-operation respectively.All had complete bone union at 3 to 5 months follow-up（mean 3.4months） with no instrument failure noted.All cases returned to normal activity and began to work at 5 months，except for 1 case developing new pathological changes at adjacent vertebra after 6 months.Conclusion：PLD is easily misdiagnosed on its early stage due to lack of specificity on clinical symptoms.Conservative treatment is effective for young patients.Operation should be considered for patients irresponsible to conservative treatment or havng severe symptom.