Doita M, Marui T, Kurosaka M, Yoshiya S, Tsuji Y, Okita Y, Oribe T
Department of Orthopedic Surgery, Saiseikai Hyogo Hospital, Kobe, Japan.
Spine (Phila Pa 1976). 2001 Jul 1;26(13):E303-7. doi: 10.1097/00007632-200107010-00027.
A case report.
To report and discuss a case of contained rupture of the aneurysm of common iliac artery associated with pyogenic vertebral spondylitis, so that investigators and practitioners may avoid the diagnostic and therapeutic pitfalls associated with pyogenic vertebral spondylitis and aortic disease.
Pyogenic vertebral spondylitis is a rare disorder that may have serious consequences, including death, if it is not diagnosed promptly and treated effectively. The association of pyogenic vertebral spondylitis with infection of the aorta is a rare but potentially fatal condition that requires prompt diagnosis and aggressive surgical and medical therapy. To our knowledge, this is the first report of a contained rupture of the aneurysm of common iliac artery case associated with pyogenic vertebral spondylitis resulting from an infection with Bacteroides fragilis,although Salmonellae infections are commonly associated with vertebral osteomyelitis and lesions of the contiguous aorta.
A 60-year-old man with chronic lower back pain began to experience a severe pain and had increased difficulty in walking. An MRI scan showed an increased signal in the L4-L5 disc space and an abscess extending into the spinal canal. The presumptive diagnosis was infective spondylitis. While performing a CT-guided needle biopsy, an unexpected contained rupture of the aneurysm of common iliac artery was discovered.
A wide resection of all infected tissue, including the right common iliac artery and bony lesions, was performed in combination with antimicrobial therapy. A cryopreserved aortic allograft was used to reconstruct the artery, and an iliac strut graft was used to fill the debrided vertebral cavity. The patient's postoperative recovery was uneventful.
The coexistence of pyogenic vertebral spondylitis and lesions of the aorta is rare, but may be lethal if not diagnosed promptly and treated effectively. Even if a patient's condition is stable and the hematocrit is normal, it is important to consider the possibility of a contained rupture of a mycotic abdominal aneurysm in all patients with vertebral osteomyelitis who have acute episodes of unusual severe back pain. CT is sometimes more beneficial than MRI in the identification and characterization of contained rupture of aneurysms.
病例报告。
报告并讨论一例伴有化脓性脊椎炎的髂总动脉瘤局限性破裂病例，以便研究人员和从业者避免与化脓性脊椎炎和主动脉疾病相关的诊断和治疗陷阱。
化脓性脊椎炎是一种罕见疾病，若不及时诊断和有效治疗，可能会产生严重后果，包括死亡。化脓性脊椎炎与主动脉感染相关是一种罕见但可能致命的情况，需要及时诊断并积极进行手术和药物治疗。据我们所知，这是首例因脆弱拟杆菌感染导致的伴有化脓性脊椎炎的髂总动脉瘤局限性破裂病例报告，尽管沙门氏菌感染通常与脊椎骨髓炎及相邻主动脉病变相关。
一名60岁慢性下背痛男性开始出现剧痛且行走困难加剧。磁共振成像（MRI）扫描显示L4-L5椎间盘间隙信号增强，且有脓肿延伸至椎管。初步诊断为感染性脊柱炎。在进行CT引导下针吸活检时，意外发现髂总动脉瘤局限性破裂。
对所有感染组织进行广泛切除，包括右髂总动脉和骨病变，并联合抗菌治疗。使用冷冻保存的主动脉同种异体移植物重建动脉，并用髂骨支撑移植物填充清创后的椎腔。患者术后恢复顺利。
化脓性脊椎炎与主动脉病变并存罕见，但如不及时诊断和有效治疗可能致命。即使患者病情稳定且血细胞比容正常，对于所有患有脊椎骨髓炎且突发异常严重背痛的患者，考虑真菌性腹主动脉瘤局限性破裂的可能性也很重要。在识别和表征动脉瘤局限性破裂方面，CT有时比MRI更具优势。
