Pyogenic infection of the spine.

In a review of 442 patients in all age groups with pyogenic infection of the spine, the disease seldom involved one vertebra, as usually two or more vertebral bodies were affected. Most frequently the lumbar spine was involved, next most frequently thoracic, then cervical spine. The sacrum rarely was involved. In 219 patients the onset of the disease was acute, in 147 subacute, and in 76 mild. In the initial period of the majority of cases, the disease was misdiagnosed. Consequently, only a small proportion of these patients were referred to the authors' department in the early stage. The patients presented a great diversity of pathologic features, clinical manifestations, and various complications. There were 53 cases of fistulae, 25 cases of hypostatic abscess, eight cases of meningitis, five cases of flaccid paralysis, 12 cases of spastic paresis, three patients with paresis of the upper extremities, and three with paresis caused by cauda damage. There were 295 cases treated conservatively and 147 by operation. Conservative treatment was applied in mild cases, which were cases diagnosed with certainty and without complications. Surgical treatment was applied in severe, rapidly progressive, complicated cases, and in patients with involvement of the nervous system. The good and satisfactory results in both groups were very similar, consisting of about 98%. The percent of good results was 4.3% higher in the surgically treated patients. Also, neurologic results after operative treatment were very favorable. These results show that when the indications are properly established, both conservative and operative methods will give good and satisfactory results.(ABSTRACT TRUNCATED AT 250 WORDS)