感染椎体の掻爬と前方固定術で治療を行った頚椎化膿性脊椎炎の2症例

抄録

  Pyogenic spondylitis is relatively rare. However, mild cases are sometimes overlooked and it may spontaneously disappear in some cases. Conservative therapy with antibiotics is effective in most patients with inflammation alone. However, decompression (with/without fusion) is required in the presence of spinal cord compression-related symptoms. When vertebral body/intervertebral disk destruction results in instability or marked kyphosis, fixation is necessary. After the inflammation subsides, anterior fixation with an autograft is usually performed, followed by posterior fixation. However, recent studies have employed simultaneous anterior/posterior fixation in an increasing number of patients. Furthermore, there are several case reports in which anterior/posterior fixation using a titanium mesh cage led to a favorable course without recurrent infection. We report 2 patients with pyogenic spondylitis of the cervical vertebrae and vertebral body destruction who underwent curettage of the affected vertebral body and anterior fixation after antibiotic therapy relieved the inflammation, and review the literature. The patients were one 35- and one 56-year-old male without any medical history of note. Vertebral body biopsy did not reveal any tumor tissue. No causative bacteria were identified. In the two patients, active inflammation was not observed during surgery. After debridement of the relatively soft, affected vertebral body, anterior fixation with an autograft and a titanium plate was performed in one case, and that using an anterior distraction device (ADD) and titanium plate were used in the other patient. In the future, long-term follow-up should be performed. To date, there has been no exacerbation of the inflammation, and favorable fixation has been maintained.