Zausinger S, Schoeller K, Arzberger T, Muacevic A
Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany.
Minim Invasive Neurosurg. 2010 Apr;53(2):80-2. doi: 10.1055/s-0030-1249682. Epub 2010 Jun 8.
The surgical treatment of vertebral osteomyelitis can be complicated by severe additional diseases or the need for extensive debridement with concomitant risks. We report a case of combined surgical and radiosurgical treatment of idiopathic vertebral osteomyelitis of L4.
The patient presented with progressive enlargement of the right side of the vertebral body L4 due to chronic fibrous osteomyelitis without evidence of infection, leading to compression of nerve roots L4, L5 and the dural sac with resulting radicular paresis. During decompression of the nerve roots via a dorsal approach, massive bleeding from the inflammatory vertebral body occurred, making abortion of surgery necessary. Remnant inflammatory masses of vertebral body L4 were treated by spinal robotic radiosurgery with a high tumoricidal dose of 20 Gy without clinical and radiological signs of relapse of disease in the following three years.
We describe a case of the combined surgical and radiosurgical treatment of lumbar osteomyelitis with symptomatic nerve root compression. Dorsal decompression followed by spinal radiosurgery for the anterior vertebral parts with avoidance of potentially dangerous anterior spondylectomy led to a rapid improvement of paresis and pain with persistent control of vertebral inflammation and enlargement. The described case of close cooperation of surgeons and radiosurgeons offered an effective and functionality preserving treatment in this challenging case.
椎体骨髓炎的外科治疗可能因严重的其他疾病或需要广泛清创并伴有相关风险而变得复杂。我们报告一例L4特发性椎体骨髓炎的手术与放射外科联合治疗病例。
该患者因慢性纤维性骨髓炎导致L4椎体右侧渐进性增大，但无感染迹象，致使L4、L5神经根及硬脊膜囊受压，进而出现神经根性轻瘫。在通过后路进行神经根减压时，炎性椎体大量出血，导致手术不得不中止。L4椎体残留的炎性肿块通过脊柱机器人放射外科治疗，给予20 Gy的高肿瘤杀伤剂量，在随后三年中未出现疾病复发的临床及影像学征象。
我们描述了一例伴有症状性神经根受压的腰椎骨髓炎的手术与放射外科联合治疗病例。先行后路减压，然后对椎体前部进行脊柱放射外科治疗，避免了潜在危险的前路椎体切除术，从而使轻瘫和疼痛迅速改善，同时持续控制椎体炎症和增大。所述外科医生与放射外科医生密切合作的病例，为这一具有挑战性的病例提供了一种有效且保留功能的治疗方法。
