| Objective:To observe and compare the clinical and pathological features of brucella spondylitis and tuberculous spondylitis,as well as the features of X-ray,CT,and MRI,and find out the common and different points on the clinical,pathological,and radiological signs of the two.Statistical analysing of the characteristics of both imaging signs,so we can improve the differential diagnosis of the two,and to analyze their imaging differences with other spondylitis such as suppurative spondylitis,thus providing helps for clinical diagnosis and treatments providing imaging supports for the patient's clinical treatment and prognosis,which in turn improves the patient's quality of life.Materials and methods:Clinical data:Twelve cases of Brucella spondylitis and 20 cases of tuberculous spondylitis diagnosed from January 2014 to August 2017 were selected.Among them,in the Brucella spondylitis group,there were X-ray and CT scans.MRI was performed in 8 cases.Only MRI was performed in 4 cases and enhanced MRI in 4 cases.In the tuberculous spondylitis group,there were 17 cases of X-ray,CT,and MRI.Only MRI was performed in 3 cases,and enhanced MRI in 12 cases.group.Brucellosis spondylitis group:9 males and 3 females,aged 42 to 70 years(average 56 years old),all diagnosed by laboratory tests or pathological examinations,including 10 patients with complete clinical data and clinical manifestations Low back pain(10 cases),leg radiating pain(5 cases),lower extremity numbness(1 case),limited activity(5 cases),fever(8 cases).Tuberculous spondylitis group:13 males and 7 females,aged 21 to 77 years(mean age,43 years),all confirmed by pathological biopsy,clinical anti-tuberculosis drug test,clinical data,clinical manifestations of low back pain(20 cases),lower limb radiating pain(7 cases),lower extremity numbness(2 cases),limited activity(3 cases),fever(6 cases).Methods:All patients underwent X-ray,CT,and MRI examinations.T-wo senior radiologists read the films.The clinical and imaging features of the two groups were analyzed and compared.The general data,clinical symptoms,laboratory parameters,and site of infection were included.Involving vertebral body number,vertebral destruction position,vertebral destruction type,vertebral strengthening method,presence of paravertebral abscess,abscess site and extent,intervertebral space stenosis,osteopetrosis,vertebral body flattening,Infringement of attachments and muscles,sequestrum,infringement of the spinal canal,cross-joint,etc.The same opinion is valid for reading.Data was analyzed by using IBM SPSS Statistics 20 statistical software.Fisher's exact test was used to count the data.p<0.05 indicated that the difference was statistically significant.Results:1.Among the 12 cases of brucella spondylitis,10 were located at the lumbosacral vertebrae,3 were at the thoracic vertebrae,3 were at the cervical spine,8 were invasive bone destruction,7 were invaded by 2 vertebrae,and 4 were invaded.There were 4 cases of vertebral body,1 case of violation of 6 vertebrae,3 cases of jumping disease,9 cases of paravertebral abscesses,4 cases of sclerotic edges,5 cases of invading attachment,and 4 cases of death.In bone,there were 6 cases of invasion of the spinal canal,and 3 cases of violation of surrounding muscles;in 10 patients with Brucella spondylitis with clinical data,there were 3 cases of low back pain(repeated),and low back pain was progressive.There were 4 cases with aggravation and 4 cases with low back pain without obvious features.There were 2 cases of high fever,4 cases of low fever,3 cases of fever(unknown),1 case of no fever,5 cases of limited activity,and 5 cases of leg pain.In one case,numbness in the lower extremities,one case of night sweats,and one case of leukocytosis,eight patients with laboratory examinations all had different degrees of ESR and increased C-reactive protein;a total of 37 patients in brucella spondylitis were infringed.Vertebral body,invading the anterior and superior endplates in 1 case,the anterior lower endplate in 1 case,the posterior upper endplate in 2 cases,the posterior lower endplate in 1 case,the upper endplate in 9 cases,and the lower endplate in 9 cases Involved in the central vertebral body in 18 cases,vertebral body flattened in 2 cases,osteolytic destruction in 4 cases,invasive destruction in 33 cases,diffuse destruction in 22 cases,localized in 15 cases;lesions involving 20 intervertebral discs,severe intervertebral space Narrowing in 9 cases,mild narrowing in 6 cases,no narrowing in 5 cases;abscess in 9 cases of abscesses in 3 cases around the vertebral body,vertebral body abscess in 1 case,anterior inferior ligament abscess in 1 case,vertebral Body abscess in 4 cases,unilateral psoas muscle abscess in 1 case,bilateral psoas muscle abscess in 1 case,unilateral erector spinae abscess in 2 cases,bilateral erector spinae abscess in 0 cases,abscess range of<3 vertebrae In 8 cases,? 3 vertebral bodies,of which there are enhanced in 4 cases,the abscess wall was significantly enhanced in 1 case,moderate enhancement in 3 cases.2.Among the 20 cases of tuberculous spondylitis infection,14 cases were located at the lumbosacral vertebrae,8 cases were located at the thoracic vertebrae,3 cases involved the cervical vertebrae,1 involved the neck,chest,and lumbosacral sp:ine,and 20 cases showed osteolytic bone destruction.Infringement of 2 vertebrae in 8 cases,infringement of 3 vertebrae in 5 cases,infringement of 4 vertebrae in 2 cases,infringement of 5 vertebrae in 1 case,violation of 6 vertebrae in 1 case,violation of 6 or more vertebral bodies in 3 cases,Two cases showed a jumpy onset.18 cases developed paravertebral abscesses,10 cases had sclerotic edges,16 cases invaded the accessory,17 cases formed sequestrum,13 cases invaded the spinal canal,and 12 cases violated surrounding muscles.20 patients with clinical data of tuberculous spondylitis,there are 5 cases of low back pain(repeated),low back pain(persistent)in 6 cases,5 cases of low back pain worsening,low back pain There were 4 cases with no obvious features,no pain,1 case of high fever,5 cases of low fever,14 cases of no fever,3 cases of limited activity,7 cases of leg radiating pain,2 cases of lower extremity numbness,and 5 cases of night sweats.The number of white blood cells increased in 4 cases,there were 18 cases with different degrees of erythrocyte sedimentation rate,and 15 cases with C-reactive protein;a total of 74 vertebrae were invaded in patients with tuberculous spondylitis,and the former upper endplate was invaded.4 cases,6 cases of anterior lower endplate,0 cases of posterior upper endplate,0 cases of posterior lower endplate,16 cases of upper endplate,18 cases of lower endplate,24 cases of violation of central vertebral body,and 24 cases of vertebral body flattening.There were 64 cases of osteolytic destruction,10 cases of invasive destruction,67 cases of diffuse range of destruction,7 cases of localized lesions,34 cases of involvement of the disc in the lesion,24 cases of severe narrowing of the intervertebral space,3 cases of mild narrowing,and no change.Narrow in 7 cases;abscess in 18 cases of abscesses,14 cases around the vertebral body,1 case of bilateral abscess,1 case of anterior longitudinal ligament abscess,0 cases of posterior vertebral abscess,unilateral psoas muscle abscess 7 Cases,bilateral psoas muscle abscess in 3 cases,unilateral erector spinae abscess in 1 case,bilateral erector spinae abscess in 1 case,abscess range of<3 vertebrae in 5 cases,? 3 vertebrae in 13 cases,including In 11 cases,the abscess wall was significantly strengthened in 7 cases and moderately intensified in 4 cases.3.There was statistical difference of the two in age,presence or absence of sequestrum,type of vertebral destruction,range of vertebral destruction,posterior vertebral abscess,abscess involvement range.(P<0.05).Conclusion:Age,presence or absence of sequestrum,type of vertebral destruction,range of vertebral destruction,,abscess involvement range have some help for brucellosis spondylitis and tuberculous spondylitis differential diagnosis.It is of great significance to master the clinical features and imaging features of the two for the early diagnosis and timely treatment. |
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