Cahill D W, Love L C, Rechtine G R
Division of Neurosurgery, University of South Florida, College of Medicine, Tampa.
J Neurosurg. 1991 Jun;74(6):878-86. doi: 10.3171/jns.1991.74.6.0878.
The authors report 10 cases of spontaneous pyogenic spinal osteomyelitis encountered within a 3-year period. There were six women and four men, ranging in age from 60 to 84 years. Six cases occurred at the thoracic level, three at the lumbar level, and one in the cervical spine. No patient was diabetic, immunocompromised, or receiving steroid therapy, and none had a history of endocarditis or intravenous drug abuse. No patient had undergone previous spinal surgery. There were no instances of coexisting tuberculosis or malignancy. Contemporaneous cases with known predisposing factors have been excluded from this report; however, three patients did have a recent history of somatic infection, one with known sepsis. All 10 patients had been previously misdiagnosed, frequently by neurosurgeons and orthopedists as well as by internists and family practitioners. Three had undergone inappropriate or unnecessary surgical procedures, and two had received inappropriate radiation therapy. Seven cases were caused by Staphylococcus species. Gram-negative bacteria, or anaerobic infections. In the other three, no bacteriological diagnosis was made, secondary to prolonged antibiotic therapy before surgery. Each patient had developed symptomatic neural element compression, spinal instability, or both by the time of their referral. The patients with subcervical pyogenic spinal osteomyelitis underwent transthoracic or retroperitoneal decompression and corpectomy with simultaneous autologous bone grafting, followed by 6 weeks of bed rest and 6 weeks of intravenous broad-spectrum or organism-specific antibiotic therapy. They were then mobilized in orthoses for an additional 6 weeks. In no case were foreign implants employed or further stabilization procedures necessitated. One patient required an additional 6 weeks of antibiotics for recalcitrant Pseudomonas colonization. Despite the patients' advanced age and the extensive surgical procedures, there was no mortality and no neurological morbidity. All patients were asymptomatic or demonstrated objective improvement upon discharge from the hospital. In this subset of patients with spontaneous pyogenic vertebral osteomyelitis, the only predisposing factor was advanced age.
作者报告了3年内遇到的10例自发性化脓性脊柱骨髓炎病例。其中女性6例，男性4例，年龄在60至84岁之间。6例发生在胸段，3例发生在腰段，1例发生在颈椎。所有患者均无糖尿病、免疫功能低下或接受类固醇治疗，也无感染性心内膜炎或静脉药物滥用史。所有患者均未接受过脊柱手术。不存在合并结核或恶性肿瘤的情况。本报告排除了有已知易感因素的同期病例；然而，3例患者近期有躯体感染史，其中1例已知患有败血症。所有10例患者之前均被误诊，经常被神经外科医生、骨科医生以及内科医生和家庭医生误诊。3例接受了不适当或不必要的手术，2例接受了不适当的放射治疗。7例由葡萄球菌属、革兰氏阴性菌或厌氧菌感染引起。另外3例由于术前长期使用抗生素，未做出细菌学诊断。每位患者在转诊时均已出现有症状的神经受压、脊柱不稳定或两者皆有。颈椎以下化脓性脊柱骨髓炎患者接受了经胸或经腹膜后减压及椎体次全切除术，并同时进行自体骨移植，随后卧床休息6周，静脉注射广谱或针对病原体的抗生素治疗6周。之后再佩戴矫形器活动6周。无一例使用异体植入物或需要进一步的稳定手术。1例患者因顽固性假单胞菌定植需要额外使用6周抗生素。尽管患者年龄较大且手术范围广泛，但无死亡病例，也无神经功能障碍。所有患者出院时均无症状或有客观改善。在这组自发性化脓性椎体骨髓炎患者中，唯一的易感因素是高龄。
