PDF(Pubmed)
Abstract：
This paper describes a case of serious complications following vertebral augmentation resulting from a misdiagnosis of pyogenic spondylitis as osteoporotic compression fracture (OCF). A 56-year-old female with systemic lupus erythematosus underwent vertebral augmentation following a diagnosis of T10 OCF based on plain film analysis. Note that preoperative computed tomography (CT) and magnetic resonance imaging (MRI) were not performed. One day after vertebral augmentation, the patient experienced a recurrence of low back pain with fever and paraplegia. MRI findings revealed paravertebral and epidural soft tissue over T9 and T10 with cord compression. Subsequent laminectomy of T9 and T10 revealed devitalized lamina, epidural abscess, and granulation tissue. Pathological analysis indicated a combination of acute and chronic inflammation. A pus culture identified Staphylococcus aureus, indicative of pre-existing pyogenic spondylitis. Further revision surgery was performed at another hospital. The patient remained in a paraplegic state one year after surgery. Infectious spondylitis often manifests with nonspecific symptoms similar to those of compression fracture, and plain radiographs are insufficient to differentiate between the two, often leading to misdiagnosis and mistreatment. Nonetheless, many practitioners base preoperative planning solely on plain film imaging. We advocate the routine usage of CT and/or MRI for patients diagnosed with compression fractures, particularly for immunocompromised individuals.
摘要：
本文介绍了一例由于化脓性脊柱炎误诊为骨质疏松性压缩骨折（OCF）而导致的椎体扩张后严重并发症。根据平片分析诊断为T10OCF后，一名56岁的女性系统性红斑狼疮患者接受了椎体增强。请注意，未进行术前计算机断层扫描（CT）和磁共振成像（MRI）。椎体扩张后的一天，患者出现了腰背痛复发，并伴有发热和截瘫。MRI结果显示T9和T10上的椎旁和硬膜外软组织伴有脊髓压迫。随后的T9和T10椎板切除术显示椎板失活，硬膜外脓肿,和肉芽组织。病理分析表明急性和慢性炎症的组合。脓液培养鉴定金黄色葡萄球菌，指示预先存在的化脓性脊柱炎。在另一家医院进行了进一步的翻修手术。手术后一年，患者仍处于截瘫状态。感染性脊柱炎通常表现为类似于压缩性骨折的非特异性症状，普通射线照片不足以区分两者，常导致误诊和误治。尽管如此，许多从业者的术前计划完全基于平片成像。我们提倡对诊断为压缩性骨折的患者常规使用CT和/或MRI，特别是对于免疫受损的个体。
