Diagnosis and modern surgical treatment of pyogenic osteomyelitis of the spine / 中国矫形外科杂志

ABSTRACT

[Objective]To explore the characteristics and management of pyogenic osteomyelitis of the spine.[Method]Thirty-nine patients with pyogenic osteomyelitis of the spine,who were treated by single-stage anterior debridement and interbody bone graft fusion,were included.The clinical presentations,laboratory,biological as well as radiological characteristics and surgical outcomes were investigated.[Result]The mean follow-up duration was 8.5 years,ranging from 2 to 17 years.All the patients had marked improvement in their back pain,17 of whom obtained complete recovery,the remaining 22 patients had occasional mild pain.Sensory deficit aggravated in 1 patient,the remaining 38 patients had marked improvement in the neurological function of the lower extremity.The recovery rate of clinical symptoms and signs ranged from 20% to 100%(averaged,75.6%).Bony fusion was obtained in all the patients in 4 months on average(ranged,2～6 months).ESR decreased from 73mm/h preoperatively to 29mm/h at 4 months after operation,while C reactive protein decreased to normal.There was no death and no other complication relating to opertion.Species of pathogenculture positive in 19 cases(48.7%).Of these,S.aureus in 10 cases,et al.[Conclusion]The underlying diseases of patients were risk factors of pyogenic osteomyelitis of the spine,pathogens involved not only S.aureus but also other low virulent organisms.CRP was more sensitive than ESR or white cell counts,it may also be the parameter to evaluate outcomes of therapy.MRI has been shown to have the highest sensitivity,specificity and accuracy in the diagnosis of pyogenic osteomyelitis of the spine.Single-stage anterior debridement and interbody bone graft fusion are save and effective to treat pyogenic osteomyelitis of the spine.