Fichte Susanne, Brodhun Michael, Göttinger Sascha, Rosahl Steffen, Klisch Joachim, Gerlach Rüdiger
Klinik für Neurochirurgie, HELIOS Klinikum Erfurt, Erfurt, Germany.
Institut für Pathologie und Neuropathologie, HELIOS Klinikum Erfurt, Erfurt, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2013 Dec;74 Suppl 1:e188-92. doi: 10.1055/s-0033-1342930. Epub 2013 May 13.
Actinomycosis of the spine with spinal cord compression is rare. Only 22 cases are reported in the literature. The authors describe a remarkable case of a large lesion leading to bony destruction and spinal cord compression in the cervicothoracic junction with a large intrathoracic extension, which was considered to be a metastatic pulmonary disease but turned out to be actinomycosis.
A 55-year-old man presented with acute tetraparesis. Magnetic resonance imaging (MRI) and computed tomography (CT) imaging showed vertebral body collapse of T1 and partially C7 with spinal cord compression as well as a mass in the right upper lobe with multiple intrapulmonary nodules. Moreover, dorsal elements (laminae and spinous process) were also involved and partially destructed. Differential diagnosis favored metastatic pulmonary disease.
Decompression surgery was performed by anterior corpectomy of T1, stabilization with an expandable titanium cage and additional anterior plate C7-T2. Histology revealed typical sulfur granules. Microbiology exams were positive for Actinobacillus actinomycetemcomitans. There was no proof of malignancy in thoracic biopsy in the late diagnostic work-up. To prevent instrumentation failure, an external immobilization (halo fixation) was applied until complete fusion was documented in CT during the postoperative course. After an 11-month course of ampicillin/sulbactam, there was complete resolution of the intrapulmonary and spinal pathology.
Thoracic actinomycosis with spinal involvement is a rare disease. Therefore, diagnosis may be difficult. Surgical intervention, correct diagnosis, and specific long-term antibiotic treatment resulted in favorable outcome.
脊柱放线菌病伴脊髓受压较为罕见。文献中仅报道了22例。作者描述了一例显著病例，在颈胸交界处出现一个大的病变，导致骨质破坏和脊髓受压，并伴有巨大的胸腔内延伸，最初被认为是转移性肺部疾病，但最终确诊为放线菌病。
一名55岁男性出现急性四肢轻瘫。磁共振成像（MRI）和计算机断层扫描（CT）显示T1椎体及部分C7椎体塌陷，伴有脊髓受压，以及右上叶有一个肿块和多个肺内结节。此外，背部结构（椎板和棘突）也受累并部分破坏。鉴别诊断倾向于转移性肺部疾病。
通过T1椎体前路椎体切除进行减压手术，使用可扩张钛笼进行稳定，并附加C7-T2前路钢板。组织学检查发现典型的硫磺颗粒。微生物学检查显示伴放线放线杆菌阳性。在后期诊断检查中，胸段活检未发现恶性肿瘤证据。为防止内固定失败，术后应用外部固定（头环固定），直至CT显示完全融合。经过11个月的氨苄西林/舒巴坦治疗，肺部和脊柱病变完全消退。
累及脊柱的胸段放线菌病是一种罕见疾病。因此，诊断可能困难。手术干预、正确诊断和特定的长期抗生素治疗取得了良好效果。
