Lehovsky J
Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
Baillieres Best Pract Res Clin Rheumatol. 1999 Mar;13(1):59-75. doi: 10.1053/berh.1999.0006.
Spinal osteomyelitis has been known about for centuries. Granulomatous infection was the principal offender in the past, but nowadays, with an increased number of patients at 'risk', the proportion of pyogenic infections has risen. Awareness of this is the essence of early diagnosis. The advent of magnetic resonance imaging has proved a major milestone; with its high sensitivity and specificity, it is an essential part of the diagnostic work-up. The treatment of spinal osteomyelitis follows the same basic principles as for any infection. Once the diagnosis has been established, early conservative treatment is commenced. Debridement, drainage of any abscesses, spinal decompression and stabilization are options in surgical treatment. The successful use of metallic implants to achieve correction and stabilization is probably helped by good perfusion of the vertebral body and accompanying good soft tissue coverage. The eradication of infection is therefore still possible.
脊髓炎已经被人们知晓了几个世纪。过去，肉芽肿性感染是主要病因，但如今，随着“高危”患者数量的增加，化脓性感染的比例有所上升。认识到这一点是早期诊断的关键。磁共振成像的出现被证明是一个重要的里程碑；因其高灵敏度和特异性，它是诊断检查的重要组成部分。脊髓炎的治疗遵循与任何感染相同的基本原则。一旦确诊，即开始早期保守治疗。手术治疗的选择包括清创、引流任何脓肿、脊髓减压和稳定。成功使用金属植入物来实现矫正和稳定可能得益于椎体的良好灌注以及随之而来的良好软组织覆盖。因此，根除感染仍然是可能的。
