Sobottke R, Zarghooni K, Seifert H, Faetkenheuer G, Koriller M, Michael J-W P, Delank K-S, Eysel P
Department of Orthopaedic Surgery, University of Cologne, Cologne, Germany.
Arch Orthop Trauma Surg. 2008 Oct;128(10):1047-53. doi: 10.1007/s00402-007-0553-y. Epub 2008 Jan 12.
The infection with non-tuberculous mycobacterium correlates highly with immunodeficiency. Mycobacterium xenopi (M. xenopi) is most commonly isolated in the respiratory tract, as a cause of endogenous spondylodiscitis it occurs but rarely. Only seven such cases have been reported in literature. In this paper, we present the case of an about 28-year-old HIV-positive patient with a long history of back pain. MRI of the spinal column and Positron Emission Tomography with (18)F-fluorodeoxyglucose as a tracer (F18-FDG-PET) confirmed the suspected spondylodiscitis. After performing a CT-controlled abscess drainage the patient's condition improved. Because of the severe destruction of the spinal segment concerned and because of the epidural abscess formation a vertebrectomy of T10 and surgical debridement of the paravertebral soft tissue via thoracotomy became urgently necessary. The spine was stabilized by interposing a cage and an anterolateral monobar system. M. xenopi could be proven by PCR out of the intraoperative specimen. After operation and antituberculotic therapy there was a fast convalescence. Diagnostics, therapy, and clinical outcome are discussed.
非结核分枝杆菌感染与免疫缺陷高度相关。偶发分枝杆菌（M. xenopi）最常于呼吸道分离得到，作为内源性脊椎间盘炎的病因则很少见。文献中仅报道过7例此类病例。本文介绍了一名约28岁的HIV阳性患者，其背痛病史较长。脊柱MRI及以（18）F - 氟脱氧葡萄糖为示踪剂的正电子发射断层扫描（F18 - FDG - PET）证实了疑似脊椎间盘炎。在进行CT引导下脓肿引流后，患者病情有所改善。由于相关脊柱节段严重破坏且形成了硬膜外脓肿，紧急需要对T10进行椎体切除术，并通过开胸手术对椎旁软组织进行手术清创。通过置入椎间融合器和前路单棒系统稳定脊柱。术中标本经PCR检测证实为偶发分枝杆菌。术后经抗结核治疗，患者迅速康复。文中讨论了诊断、治疗及临床结果。
