化膿性脊椎炎の治療経験

抄録

  Objective : Pyogenic spondylitis (PS) is rare but serious condition. Delayed treatment may lead to increased morbidity and mortality. Authors focus on the prompt diagnosis and management of PS and present the clinical outcome in consecutive 10 patients.

  Methods : Ten cases of PS treated over the past 6 years were analyzed retrospectively. There were 9 males and 1 female with the mean age of 67.1 years old. Six of 10 cases were clearly immunocompromised, including 3 cases of chronic renal failure, 1 of advanced gastric cancer, 1 of liver dysfunction and 1 of diabetes mellitus. All cases received surgical drainage of infection affected area to isolate the pathogens early after systemic evaluation, and underwent surgical decompression with/without the posterior stabilization with spinal instrumentation. Antibiotic treatment was maintained until the infection was controlled completely.

  Results : Cervical spine was affected in 7 of 10 cases (70%). Clinical course of infection spread was acute in 7 cases, subacute in 2 cases and gradual in 1 case. Surgical culture isolated the pathogens in 7 of 10 cases. Early surgery followed by antibiotic treatment appeared to result in spinal cord decompression and neurological recovery.

  Conclusion : Early diagnosis is crucial in the management of PS. Once the presence of PS has been established, all appropriate cultures, including surgical drainage, need to be obtained without delay. Surgical decompression with/without the posterior instrumented stabilization of the spine may play a role in the cases of neurological deficit with spinal cord compression.