ĐẶC ĐIỂM LÂM SÀNG, SINH HOÁ VÀ CT-SCAN TRONG VIÊM THÂN SỐNG ĐĨA ĐỆM DO LAO VÀ VI KHUẨN SINH MỦ

Abstract

Background: Spondylodiscitis is an uncommon infectious disease that can lead to severe complications if diagnosis and treatment are delayed. Differentiating between tuberculous and pyogenic etiologies remains challenging due to overlapping clinical and imaging features. Objective: To compare the clinical presentation, biochemical markers, and computed tomography (CT) findings between patients with tuberculous and pyogenic spondylodiscitis. Methods: This observational study, combining retrospective and prospective data, included 73 patients diagnosed with spondylodiscitis at the University Medical Center Ho Chi Minh City between August 2023 and August 2025. Among them, 24 cases were due to Mycobacterium tuberculosis and 49 were due to pyogenic bacteria. Clinical features, biochemical parameters, and CT characteristics were analyzed and compared between the two groups. Results: Clinical manifestations were similar between tuberculous and pyogenic spondylodiscitis, including weakness (12.5% vs. 12.2%), paresthesia (25.0% vs. 32.7%), fever (37.72°C vs. 37.73°C), and urinary retention (0.0% vs. 14.3%; p = 0.088). In the pyogenic group, CRP (132.68 vs. 80.94 mg/L; p = 0.035), procalcitonin (0.54 vs. 0.14 ng/mL; p = 0.031), and HbA1C (7.64% vs. 5.91%; p = 0.036) were significantly higher, whereas IGRA positivity was more frequent in the tuberculous group (53.8% vs. 7.1%; p = 0.001). CT findings such as bone destruction and paraspinal abscesses were common in both groups without significant differences. Conclusion: Clinical and CT features of tuberculous and pyogenic spondylodiscitis show substantial overlap, reflecting disease severity rather than etiology. In contrast, biochemical markers—particularly CRP, procalcitonin, and IGRA—provide greater discriminatory value. Combining laboratory and imaging assessments can enhance diagnostic accuracy and guide appropriate management. Keywords: Spondylodiscitis; spinal tuberculosis; pyogenic spondylitis; computed tomography; CRP; procalcitonin; IGRA.