Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center/Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito, Ibaraki, 310-0015, Japan.
Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
J Med Case Rep. 2023 May 13;17(1):211. doi: 10.1186/s13256-023-03942-w.
Pyogenic spondylitis by methicillin-resistant Staphylococcus aureus (MRSA) is known to be intractable. In the past, the insertion of an implant into infected vertebra was considered contraindicated in affected patients because it may exacerbate the infection, but there are increasing numbers of reports indicating the usefulness of posterior fixation to correct instability and alleviate infection. Bone grafting is often required to repair large bone defect due to infection, but free grafts can exacerbate infection and are controversial.
We present the case of a 58-year-old Asian man with intractable pyogenic spondylitis who had repeated septic shocks due to MRSA. Back pain from repeated pyogenic spondylitis caused by a huge bone defect in L1-2 rendered him unable to sit. Posterior fixation by percutaneous pedicle screws (PPSs) without bone transplantation improved spinal stability and regenerated bone in the huge vertebral defect. He regained his activities of daily living, had no reoccurrence of pyogenic spondylitis nor bacteremia, and was completely cured of the infection without antibiotics after removal of all screws.
For intractable MRSA pyogenic spondylitis with instability accompanied by a huge bone defect, posterior fixation using PPSs and administration of antibacterial agents stopped the infection, allowed the bone to regenerate, and recovered the patient's activities of daily living.
耐甲氧西林金黄色葡萄球菌（MRSA）引起的化脓性脊柱炎难以治疗。过去，由于植入物可能会加重感染，因此在受影响的患者中，将植入物插入感染的椎骨被认为是禁忌的，但越来越多的报告表明后路固定对于纠正不稳定和缓解感染是有用的。由于感染，通常需要进行骨移植来修复大的骨缺损，但游离植骨会加重感染，存在争议。
我们报告了一例 58 岁的亚洲男性，患有耐甲氧西林金黄色葡萄球菌引起的难治性化脓性脊柱炎，因 MRSA 反复发生感染性休克。由于 L1-2 的巨大骨缺损导致反复发作的化脓性脊柱炎，患者腰痛导致无法坐立。通过经皮椎弓根螺钉（PPS）进行后路固定，无需骨移植，改善了脊柱稳定性，并在巨大的椎体缺损处再生了骨。他恢复了日常生活活动能力，没有再次发生化脓性脊柱炎或菌血症，在取出所有螺钉后，无需使用抗生素就完全治愈了感染。
对于伴有巨大骨缺损的难治性耐甲氧西林金黄色葡萄球菌化脓性脊柱炎，使用 PPS 的后路固定和抗菌药物的应用可控制感染，促进骨再生，恢复患者的日常生活活动能力。
