Ozuna R M, Delamarter R B
Department of Orthopaedic Surgery, UCLA Medical Center, USA.
Orthop Clin North Am. 1996 Jan;27(1):87-94.
The presentation and clinical course for hematogenous vertebral osteomyelitis and postoperative discitis is presented. The treatment is primarily conservative care in the form of immobilization and parenteral antibiotics. The indications for surgery are rare and should be reserved for patients resistant to treatment or with septic course, abscess formation, or neurologic deficits. In these cases, the infectious process has generally involved the adjacent vertebrae or the neural elements. Surgery usually involves an anterior approach. The principles of surgical treatment involve debridement of necrotic tissue, decompression of neural elements, and stabilization of the spine. The outcome of patients with vertebral osteomyelitis and secondary discitis in general is favorable when appropriate treatment is rendered. Extension of the infection to the spinal canal in the form of an epidural abscess is also reviewed.
本文介绍了血源性椎体骨髓炎和术后椎间盘炎的临床表现及临床病程。治疗主要以固定和胃肠外使用抗生素的形式进行保守治疗。手术指征罕见，应仅用于对治疗有抵抗或有败血症病程、脓肿形成或神经功能缺损的患者。在这些情况下，感染过程通常累及相邻椎体或神经结构。手术通常采用前路入路。手术治疗原则包括清除坏死组织、减压神经结构和稳定脊柱。一般来说，当给予适当治疗时，椎体骨髓炎和继发性椎间盘炎患者的预后良好。本文还综述了以硬膜外脓肿形式将感染扩展至椎管的情况。
