Liebergall M, Chaimsky G, Lowe J, Robin G C, Floman Y
Department of Orthopaedic Surgery, Kiryat Hadassah, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Clin Orthop Relat Res. 1991 Aug(269):142-50.
In the interval between 1983 and 1988, 14 patients were treated for pyogenic spondylitis complicated by neurologic compromise. There were nine males and five females aged 39-80 years. The average time between onset of symptoms and diagnosis was 2.8 months. Predisposing factors were diabetes mellitus in four patients and urinary tract infections in five patients. The infection was blood borne in all 14 patients. In two patients, the infection was superimposed on a recent vertebral fracture. The cervical spine was involved in one patient; the thoracic spine in seven; and the lumbar spine in six patients. Six patients presented with a Frankel B paralysis, six with a Frankel C paralysis, and two with grade D paralysis. The neurologic symptoms lasted between one day and six weeks before surgery. Twelve patients had anterolateral decompression. Two of the 12 patients had a second stage posterior stabilization. Two patients were deemed inoperable. All surviving patients were managed by parenteral antibiotics for three to six weeks followed by enteral route for a total of three to six months. All 12 operated patients had a significant neurologic improvement (one grade or more on the Frankel scale) with solid interbody fusion.
在1983年至1988年期间，14例化脓性脊柱炎合并神经功能障碍患者接受了治疗。其中男性9例，女性5例，年龄在39至80岁之间。症状出现至诊断的平均时间为2.8个月。易感因素包括4例患者患有糖尿病，5例患者患有尿路感染。所有14例患者的感染均为血行性感染。2例患者的感染叠加在近期的椎体骨折上。1例患者颈椎受累；7例胸椎受累；6例腰椎受累。6例患者表现为Frankel B级瘫痪，6例为Frankel C级瘫痪，2例为D级瘫痪。神经症状在手术前持续1天至6周。12例患者接受了前路减压。12例患者中有2例进行了二期后路固定。2例患者被认为无法手术。所有存活患者均接受了3至6周的静脉抗生素治疗，随后改为肠内途径，总共治疗3至6个月。所有12例接受手术的患者在椎间融合牢固的情况下神经功能均有显著改善（Frankel分级提高一级或更多）。
