Treatment of Non - tuberculous Infection of the Spine

Lee, Han Koo; Choi, In Ho

Abstract

During the period of 25 years from Apr. 1959 to Jan. 1984, 58 patients of non-tuberculous infec-tion of the spine (53 pyogenic osteomyelitis and 5 iatrogenic and primary discitis) were admitted and treated at our department. Clinical analysis was carried out following results were obtained. 1. The incidence was higher in the 3rd and 4th decade and the sex ratio between male and female was 2.1:1 2. The relative frequency of the commonly involved sity were lumbar(60), thoracic(17.), cervical(9%), lumbosacral(7%), thoracolumbar(3.5%), cervicothoracic(1.5%), in that orders. 3. The morbidity period less than 1 month was only in 22% and that less than 1 year was only 4. The frequent clinical symptoms and signs were back pain(91), tenderness(88%), muscle spasm (76%), and fever and chillness(41%). 5. The causative microorganism was identified in 43 cases among which 77% was coagulase positive staphylococcus. 6. Expected spontaneous bony fusion was not found in any case of 9 follow-up cases of conservatively treated group, while excellent bony union was noticed in all 16 follow-up cases of anterior fusion group except one. 7. Anterior spinal fusion seems be to indicated in those cases such as with failure of conservative treatment, paraplegia, concomitant mechanical instability, long duration of sinus tract and even with dubious bacteriological diagnosis. 8. Anterior spinal fusion for pyogenic osteomyelitis and discitis has the advantages, that is eradication of diseased foci with easier bacteriological diagnosis, cord decpmpression, increase of bony stability, and promotion of bony union. 9. Laminectomy was indicated in those cases with epidural abscess. 10. Bone scan and computed tomography were useful in the early diagnosis and evaluation of treatment results.