PYOGENIC INFECTION OF THE SPINE

Abstract

Twenty-seven cases of baterial vertebral osteomyelitis during the period Dec. 1986 to Dec. 1995, were analyzed. The ages of the 13 men and 14 women ranged from 23 to 69 years. The main clinical symptoms were lower back pain and a knocking pain, with only 7 patients presenting with fever at the time of admission. Nineteen patients had white cell counts of more than 9000/cumm, and the sedimentation rate was significnatly elevated in 24 of 27 patients. Operation procedures were performed in 19 patients of which 15 patients underwent anterior fusion and bone graft and 4 patients had debridement only. One patient underwent posterior fusion 4 weeks after the anterior debridement with Harrington instrumentation. Other patients underwent bone biopsy under CT guidance and were treated by intravenous antibiotics and bed rest only. Bone union occurred after a period of between 2 months and eleven months. Surgery was indicated if an abscess was present, neurological complications occurred, instability

Pyogenic infection of the spine has been regarded as rare or uncommon. Kuloskil in 1936 reported the earliest large series of 102 cases. It may present diagnostic difficulties, as it often had an insiduous onset. Lower back pain is often ignored, and radiological changes may take weeks or months to develop. Neurological compromise can and does occur when treatment is delayed. Howerver, the increasing use of diagnostic instruments including CT scan and MR imaging has markedly improved the diagnostic rate. From 1986 to 1995 we reviewed 27 cases with proven osteomyelitis of the spine by pathology. This is a report of our experience with clinical presentation, diagnosis and surgical treatment of pyogenic osteomyelitis of the spine.