Lim Dong-Ju
Department of Orthopaedic Surgery, Seoul Spine Institute, Sanggye Paik Hospital, College of Medicine, Inje University, Republic of Korea.
Int J Surg Case Rep. 2022 Dec;101:107816. doi: 10.1016/j.ijscr.2022.107816. Epub 2022 Nov 29.
Syphilis is a sexually transmitted disease that appears in various organs. Neurosyphilis in the spine is infrequent, and report of failed spinal arthrodesis surgery is rare. We report the first presentation of complete bone fusion in failed back surgery syndrome with teriparatide.
A 65-year-old man presented to the outpatient clinic after being admitted to the spine department. The patient visited the neurology department 30 years prior for syphilitic myelitis and had been walking with a cane. He underwent an L5-S1 stenosis operation earlier. Severe proximal adjacent L4-L5 level stenosis was observed due to syphilitic gumma with cauda equina syndrome. A posterior decompression and posterolateral fusion to S1 were performed. Four weeks post-surgery, bilateral lower extremity muscle weakness recurred, and a radiographic examination revealed bilateral posterior screw loosening and fracture of the fourth lumbar vertebrae body. After the stagnant fluid and metal removal, for the augmentation of bone union, teriparatide was used for six months, and a complete bone union was confirmed by radiography without pain.
Spinal syphilitic gumma has been rarely reported, most of which undergo surgical treatment. Surgical decompression and fixation with a pedicle screw are usually needed. There are complications after spinal surgery using a pedicle screw fixation, and parathyroid hormone (PTH) might be suitable for application in the prevention of nonunions or to augment bone fusion.
This case report is the first description of complete spinal bone fusion in failed back surgery syndrome using teriparatide in tertiary syphilis.
梅毒是一种可累及多个器官的性传播疾病。脊柱神经梅毒较为罕见，脊柱融合手术失败的报道也很少见。我们报告了首例使用特立帕肽治疗失败的脊柱手术综合征并实现完全骨融合的病例。
一名65岁男性在脊柱科住院后到门诊就诊。该患者30年前因梅毒性脊髓炎就诊于神经内科，此后一直拄着拐杖行走。他早些时候接受了L5-S1狭窄手术。由于梅毒瘤导致严重的近端相邻L4-L5节段狭窄并伴有马尾综合征。进行了后路减压和至S1的后外侧融合术。术后四周，双侧下肢肌肉无力复发，影像学检查显示双侧后路螺钉松动以及第四腰椎椎体骨折。在清除积液和取出金属物后，为促进骨愈合，使用特立帕肽治疗六个月，影像学检查证实实现了完全骨愈合且患者无痛。
脊柱梅毒瘤的报道很少，大多数病例接受手术治疗。通常需要进行手术减压并用椎弓根螺钉固定。使用椎弓根螺钉固定进行脊柱手术后会出现并发症，甲状旁腺激素（PTH）可能适用于预防骨不连或促进骨融合。
本病例报告首次描述了在三期梅毒患者中使用特立帕肽治疗失败的脊柱手术综合征并实现完全脊柱骨融合的情况。
