PDF(Pubmed)
Abstract：
Pyogenic spondylitis is a rare life-threatening condition. Conservative treatment with antibiotics is indicated; however, surgery can be considered in refractory cases. The surgical strategy varies, as pyogenic spondylosis can occur from the cervical to sacral regions. To our knowledge, although there is less invasiveness as an advantage in the following management, cervical and thoracic-lumbar-sacral circumferential fixations in two sessions for pyogenic spondylitis have not been previously described. An 84-year-old man complained of ambulation disturbances and pain in the neck and upper and lower extremities (the Japan Orthopaedic Association cervical myelopathy evaluation questionnaire score of 5/17). Magnetic resonance imaging revealed pyogenic spondylitis of the cervical, thoracic, and lumbar regions. Epidural abscesses and spondylodiscitis were concurrently diagnosed with multi-level skipping lesions from the cervical to the sacral regions. As these lesions were resistant to antibiotic treatment and the neurological symptoms worsened, surgical treatment was planned. Anterior cervical discectomy and fusion, and posterior cervical fixation were followed by oblique and posterior lumbar intervertebral fusions with long-level fixation from T12 to the ilium using percutaneous pedicle screws. The surgeries were performed in two sessions to avoid the invasiveness of surgeries in a single session. The patient\'s condition improved after a second surgery. The patient was discharged on postoperative day 116. No recurrence was observed for six months, and the patient was able to ambulate independently. Two-stage cervical and thoracic-lumbar-sacral circumferential fixation for pyogenic spondylitis contributed to a favorable outcome (the Japan Orthopaedic Association cervical myelopathy evaluation questionnaire score of 13/17).
摘要：
化脓性脊柱炎是一种罕见的危及生命的疾病。需要使用抗生素进行保守治疗；然而，难治性病例可考虑手术治疗。手术策略各不相同，因为化脓性脊柱病可以从颈椎到骶骨区发生。据我们所知,尽管在以下管理中具有较少的侵入性作为优势，在化脓性脊柱炎的两个疗程中，颈椎和胸-腰-骶骨圆周固定以前没有描述。一名84岁的男子抱怨颈部，上肢和下肢的步行障碍和疼痛（日本骨科协会对脊髓型颈椎病的评估问卷评分为5/17）。磁共振成像显示颈椎化脓性脊柱炎，胸廓,和腰部区域。硬膜外脓肿和脊椎盘炎同时诊断为从颈椎到骶骨区域的多层跳跃病变。由于这些病变对抗生素治疗有抗药性，神经症状恶化，计划手术治疗。颈椎前路椎间盘切除和融合术，颈椎后路固定，然后进行斜向和后路腰椎融合，并使用经皮椎弓根螺钉从T12固定到the骨。手术分两次进行，以避免一次手术的侵入性。患者的病情在第二次手术后好转。患者在术后第116天出院。六个月没有观察到复发，病人能够独立走动。化脓性脊柱炎的两阶段颈和胸-腰-骶骨圆周固定术取得了良好的结果（日本骨科协会颈脊髓病评估问卷评分为13/17）。
