The value of modified puncture and aspiration biopsy in diagnosis of purulent discitis

English Keywords:Purulent discitis  Biopsy  Microorganisms  Lumbar

English Abstract:

  【Abstract】 Objectives: To discuss the value of modified puncture and aspiration biopsy in the diagnosis of purulent discitis. Methods: From September 2003 to October 2011 in Hong Hui Hospital, Xi′an Jiaotong University College of Medicine, 97 cases with suspected lumbar purulent discitis were reviewed retrospectively. There were 48 males and 49 females, with the age ranging from 17 to 87 years, with an average age of 61.7 years. The involved segments included: L1/2 in 7 cases, L2/3 in 14 cases, L4/5 in 33 cases, and L5/S1 in 43 cases. CT-guided biopsy puncture and aspiration was performed. According to the puncture method, all patients were divided into 3 groups. Traditional methods were used in group A(method A). On the target disc space, skin puncture needle point was located through CT-guide. and 21G needle aspirate was performed. In Group B, only normal saline was given if method A failed(method B). In Group C, if method B was failure, another 21G puncture needle was punctured into the other side, and one for injecting normal saline, and the other side for withdrawing liquid(method C). Method B and C were defined as modified puncture aspiration biopsy. Bacteria culturing of specimens was performed. Statistical method was used to test the result. Results: Biopsy specimens were taken from all patients: 41 cases in group A, 36 cases in group B, and 20 cases in group C. 97 patients underwent needle biopsy, however only 41 cases obtained specimens, which showed significant difference between method B+C and method A(P<0.05). In 97 cases, 93 cases had positive bacterial culturing(95.8%), among them, the pathogenisis included Staphylococcus aureus(50.5%, 47), streptococcus and Enterococcus 18.28%(17 cases), Escherichia coli 13.98%(13 cases), Pseudomonas 10.75%(10), the others 6.45%(6). 97 cases had routine blood culturing, of 47(48.5%) positive pathogenisis, there were Staphylococcus aureus(57.44% and 27), Streptococcus and Enterococcus 19.15%(9 cases), Escherichia coli 14.77%(6 cases), Pseudomonas 8.51%(4 cases), and other 2.13%(1 case). Positive bacterial culturing rate was significantly different compared with the rate of positive blood culturing(P<0.05). In 47 cases of patients with positive blood culturing, all showed positive bacterial culturing, which were consistent with the blood culturing. Conclusions: The modified method may improve the diagnostic rate of purulent discitis in lumbar vertebra, which is of simple and high rate of puncturing.