Abstract
Four patients (three males and one female with mean age of 64.2 years) who had lumbar pyogenic spondylitis were treated by percutaneous curettage and continuous irrigation (PN continuous irrigation). The affected intervertebral lesions were L3-L4 and L4-L5 in one patient, T11-T12 and L4-L5 in other patient and L3-L4 in the others. The operative procedure was similar to those of percutaneous nucleotomy. After curettage of the affected intervertebral disc, suction drainage tube (outer diameter, 3mm) and epidural catheter tube were inserted in the intervertebral disc space. Then irrigation with antibiotics were continued for two weeks or more.
None of the patients had responded to systemic administration of antibiotics preoperatively in another hospital. Before the operation, all patients had a severe low back pain and average C-reactive protein was 3.0mg/dl (range, 0.3-6.6mg/dl). After the operation, low back pain disappeared immediately in all patients and C-reactive protein in three patients showed a rapid decrease to normal levels (within two weeks). The causative organisms identified postoperatively in three patients were enterococcus faecalis, candida tropicalis and staphylococcus aureus. No major complications were observed in any of the patients.
MRI showed postoperative improvement in the affected lesions of all patients. After removal of drainage tubes, a high intensity area of the affected disc space on T2-weighted image disappeared between 8 and 28 weeks (an average period, 15 weeks). Both a low intensity area of the affected vertebral body on T1-weighted image and an enhanced area of the affected disc space with Gadolinium-DTPA on T1-weighted image disappeared within 28 weeks. We found MRI to be useful to evaluate the effect of treatment of pyogenic spondylitis.
