Wu Shun-Yao, Wei Ta-Sen, Chen Yen-Chun, Huang Shih-Wei
Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan.
Orthopedics. 2012 Oct;35(10):e1576-80. doi: 10.3928/01477447-20120919-34.
Vertebral osteomyelitis is rare in children. The lumbar spine is the most commonly involved region. Vertebral osteomyelitis occurs more frequently in the vertebral body, and involvement of posterior element is rare. Vertebral osteomyelitis results from hematogenous seeding, spread from contiguous infections, and direct inoculation from spinal surgery. Initial symptoms include low back pain, difficulty standing, limping gait, and fever. Blood cultures should be obtained for children with vertebral osteomyelitis because it is the definite guide for providing accurate treatment. Computed tomographyi-guided abscess aspiration should be considered for patients with negative blood cultures. Staphylococcus aureus is the most common microorganism in vertebral osteomyelitis, and the incidence of methicillin-resistant S aureus has increased in recent years. Plain radiographs, bone scintigraphy, and magnetic resonance imaging are useful for making the diagnosis. Antimicrobial therapy for 6 weeks is usually successful, and an early transition to oral form does not increase the risk of treatment failure. Debridement with implant removal is required, especially for late-onset infections associated with previous spinal surgery. Vertebral osteomyelitis can cause motor weakness and paralysis. Because of the involvement of spinal development, spinal deformities, including scoliosis and loss of normal lumbar lordosis, should be a concern in pediatric patients. Early diagnosis and adequate treatment for vertebral osteomyelitis are important to prevent severe complications and lifelong disabilities.This article describes the case of a 14-year-old boy with spontaneous lumbar vertebral osteomyelitis who initially presented with low back pain and was successfully treated nonoperatively.
儿童椎体骨髓炎较为罕见。腰椎是最常受累的部位。椎体骨髓炎更常发生于椎体，累及后部结构的情况罕见。椎体骨髓炎由血行播散、邻近感染蔓延以及脊柱手术直接接种引起。初始症状包括腰痛、站立困难、跛行步态和发热。对于患有椎体骨髓炎的儿童应进行血培养，因为它是提供准确治疗的明确指导。血培养阴性的患者应考虑计算机断层扫描引导下的脓肿抽吸。金黄色葡萄球菌是椎体骨髓炎最常见的微生物，近年来耐甲氧西林金黄色葡萄球菌的发病率有所增加。X线平片、骨闪烁显像和磁共振成像有助于做出诊断。6周的抗菌治疗通常是成功的，早期转换为口服形式不会增加治疗失败的风险。需要进行清创并取出植入物，特别是对于与既往脊柱手术相关的迟发性感染。椎体骨髓炎可导致运动无力和瘫痪。由于涉及脊柱发育，脊柱畸形，包括脊柱侧凸和正常腰椎前凸消失，在儿科患者中应引起关注。早期诊断和充分治疗椎体骨髓炎对于预防严重并发症和终身残疾很重要。本文描述了一名14岁男孩自发性腰椎椎体骨髓炎的病例，该男孩最初表现为腰痛，并通过非手术治疗成功治愈。
