Ohyama Shuhei, Inoue Masahiro, Toshi Noriyasu, Okuyama Kohei, Tokeshi Soichiro, Suzuki Noritaka, Shiga Yasuhiro, Inage Kazuhide, Yawara Eguchi, Orita Sumihisa, Ohtori Seiji
Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN.
Department of Orthopedic Surgery, Center for Frontier Medical Engineering, Chiba University, Chiba, JPN.
Cureus. 2023 Dec 16;15(12):e50636. doi: 10.7759/cureus.50636. eCollection 2023 Dec.
Pyogenic vertebral osteomyelitis (PVO) is a prevalent infection in the elderly, frequently complicated by iliopsoas and epidural abscesses. Traditional treatments are often ineffective for refractory cases. In this report, a 76-year-old man with PVO, iliopsoas, and epidural abscess was unresponsive to antibiotics, presenting with severe lower back pain and functional impairments. A two-stage surgical intervention was implemented: anterior debridement, autogenous bone graft fixation, and novel application of retroperitoneal continuous local antibiotic perfusion (CLAP), followed by posterior fixation. A contrast test verified correct CLAP perfusion into the iliopsoas abscess and intervertebral disc space. Substantial improvements were noted postoperatively, including a marked reduction in pain, inflammation, and the size of both abscesses. In conclusion, this case demonstrates the feasibility and effectiveness of retroperitoneal CLAP in treating refractory PVO, offering a potential innovative solution for cases resistant to conventional therapies.
化脓性脊椎骨髓炎（PVO）在老年人中是一种常见感染，常并发髂腰肌和硬膜外脓肿。传统治疗方法对难治性病例往往无效。在本报告中，一名76岁患有PVO、髂腰肌和硬膜外脓肿的男性对抗生素无反应，伴有严重的下背部疼痛和功能障碍。实施了两阶段手术干预：前路清创、自体骨移植固定以及腹膜后持续局部抗生素灌注（CLAP）的新应用，随后进行后路固定。造影试验证实CLAP正确灌注到髂腰肌脓肿和椎间盘间隙。术后有显著改善，包括疼痛、炎症明显减轻以及两个脓肿的大小缩小。总之，该病例证明了腹膜后CLAP治疗难治性PVO的可行性和有效性，为对传统疗法耐药的病例提供了一种潜在的创新解决方案。
