Diagnosis and Treatment of Pyogenic Spondylitis

Abstract

We report 39 patients with pyogenic spondylitis who were treated from 1987 to 2001. Their age ranged from 18 to 84 years (mean:60.3 years). The follow-up period ranged from one month to 35 months (mean:9.5 months). Seventeen patients suffered from complications, of whom 6 had diabetes mellitus, 3 had liver cirrhosis and 3 had rheumatoid arthritis. The most common pathogen was methicillin-sensitive Staphylococus aureus (MSSA, 6 cases) and methicillin-resistant Staphylococcus (MRSA, 3 cases). Ten cases had complications of the spinal epidural abscess. Thirty-eight cases were diagnosed MRI and scintigraphy. One case could not be diagnosed either by MRI or by scintigraphy at an early stage. Fifteen of these cases were treated conservatively and 24 were treated surgically, because of abscess with meningitis, neurological deficit and resistance to conservative treatment. Two out of the 10 cases of spinal epidural abscess sustained residual pain, and one showed residual neurological deficit. Fales-negative MRI results in diagnosis at early stages of pyogenic spondylitis should be noticed. Surgical treatment at an early stage is recommended for cases with these complications and/or spinal epidural abscess.