van Duijvenbode D C, Kuiper J W P, Holewijn R M, Stadhouder A
Department of Orthopaedic Surgery, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
J Orthop Case Rep. 2018 Sep-Oct;8(5):67-71. doi: 10.13107/jocr.2250-0685.1216.
Treatment and risk factors for Parvimonas micra spinal infections are scarcely researched. This study reports a case and presents a systematic review of the literature to provide evidence-based ground for diagnosis and treatment of P. micra spinal infections.
This is a case of a 78-year-old male with severe back and leg pain. Advanced imaging demonstrated the destruction of L2-L3 with an extensive fluid collection in the remaining intervertebral space, paravertebral myositis, and multiple abscesses. A decompression of L2 and L3 and a posterior spondylodesis from T12 to L5 was performed. Intraoperative cultures showed P. micra. The postoperative treatment consisted of intravenous penicillin for 2 weeks and subsequent oral clindamycin for 4 weeks. At 1-year follow-up, the patient was in good health and reported only occasional back pain.
A total of 15 additional cases of P. micraspinal infections were identified. The antibiotic treatment showed a great variety in the treated patients. Nevertheless, the outcome of these patients was good concerning relapse of the infection and pain. Spinal infections caused by P. micra are rare, but can be successfully treated according to the guidelines for spinal infection.
微小单胞菌脊柱感染的治疗及危险因素鲜有研究。本研究报告了1例病例,并对文献进行系统综述,为微小单胞菌脊柱感染的诊断和治疗提供循证依据。
本病例为一名78岁男性,有严重的腰腿痛。高级影像学检查显示L2-L3椎体破坏,剩余椎间隙有大量积液,椎旁肌炎和多个脓肿。行L2和L3减压术以及T12至L5后路脊柱融合术。术中培养显示为微小单胞菌。术后治疗包括静脉注射青霉素2周,随后口服克林霉素4周。在1年的随访中,患者健康状况良好,仅偶尔报告有背痛。
另外共确定了15例微小单胞菌脊柱感染病例。在接受治疗的患者中,抗生素治疗方式差异很大。然而,就感染复发和疼痛而言,这些患者的预后良好。微小单胞菌引起的脊柱感染很少见,但可根据脊柱感染指南成功治疗。