感染性脊椎炎に対する外科的治療

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  • Surgical Strategy for Vertebral Osteomyelitis

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The treatment of vertebral osteomyelitis and epidural abscess represents one of the greatest challenges to the spine surgeons. These diseases are complex and difficult to manage and often result in acute neurological deterioration and require a combination of adequate surgical and conservative treatments. We reviewed the surgical management and outcome of 14 patients with pyogenic or tuberculous osteomyelitis and epidural abscess. The series consisted of 14 patients (8 males and 6 females); their ages ranged from 49 to 77 years. Myelopathy or radicular pain was caused by osteomyelitis and an epidural abscess in all patients. Cervical, thoracic, and lumbar osteomyelitis was detected in 5, 6, and 3 cases, respectively; epidural abscess was pyogenic in 11 and tuberculous in 3 cases. Among them, two-stage managements were performed in 10 cases. The pathogen was identified in 9 of the 14 cases: S. aureus in 5 cases, M. tuberculosis in 3 cases and MRSA in 1 case. The postoperative course was uneventful with relief of the symptoms. No evidence of recurrence or residual infection was observed in any patient as shown by ESR and/or CRP levels during the follow-up period of an average of 27.3 months (range, 6 to 56 months). In conclusion, the strategy for osteomyelitis and abscess of the spine must provide timely neural decompression, spinal stabilization, and clearance of infection. Two-stage management appears suitable in selected patients for emergent decompression and organism-specific antibiotic treatment. The antibiotic therapy should be tailored on the basis of the culture and sensitivity results, which are the key factors in the treatment of this disease. Instrumentation can be used safely even in cases of spinal infection after the infection has been controlled with a normal CRP; however, the use should be limited only in the cases with the advantage being superior to the risk.

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  • 脊髄外科

    脊髄外科 20 (3), 165-172, 2006

    日本脊髄外科学会

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