Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Management of Lumbar Pyogenic Spondylitis with Posterior Decompression and Interbody Fusion Using Transpedicular Screws

요추부 화농성 척추염에서 후방 감압 및 척추경 나사못을 이용한 추체간 유합술

  • Cho, Byung-Ki (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Kim, Yong-Min (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Kim, Dong-Soo (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Choi, Eui-Sung (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Shon, Hyun-Chul (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Park, Kyoung-Jin (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Park, Ji-Kang (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Bae, Seung-Hwan (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University)
  • 조병기 (충북대학교 의과대학 정형외과학교실) ;
  • 김용민 (충북대학교 의과대학 정형외과학교실) ;
  • 김동수 (충북대학교 의과대학 정형외과학교실) ;
  • 최의성 (충북대학교 의과대학 정형외과학교실) ;
  • 손현철 (충북대학교 의과대학 정형외과학교실) ;
  • 박경진 (충북대학교 의과대학 정형외과학교실) ;
  • 박지강 (충북대학교 의과대학 정형외과학교실) ;
  • 배승환 (충북대학교 의과대학 정형외과학교실)
  • Received : 2010.03.22
  • Accepted : 2010.04.12
  • Published : 2010.06.30
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Abstract

Purpose: The purpose of this study is to assess the efficacy of posterior decompression and interbody fusion with posterior instrumentation in treating lumbar pyogenic spondylitis. Materials and Methods: Twenty-one patients with lumbar pyogenic spondylitis who underwent posterior decompression and lumbar interbody fusion with posterior fixation were reviewed. Clinically infection control (CRP normalization time) and rehabilitation were investigated. And radiologically, timing of achievement of fusion and changes of sagittal alignment were investigated. Results: Infection was controlled successfully without any recurrence and breakage of instrument. Stable interbody fusion was achieved in all cases within 6 months. Postoperative interval to achieve normal CRP was 28.7 (10-64) days. Ambulation was started on 5.8th (2-19) day. Sagittal angle was 12.3 degrees before operation, became more lordotic to 16.4 degrees, but decreased to 11 degrees at final follow-up. Final sagittal alignment was almost same with the preoperative status. Conclusion: By achieving favorable results clinically and radiologically, posterior decompression and interbody fusion seemed to be an effective method in management of lumbar pyogenic spondylitis.

목적: 화농성 척추염의 치료시 후방 감압 및 후방 기기사용 추체 간 유합술의 효과를 알아보고자 하였다. 대상 및 방법: 요추부의 화농성 척추염 환자 중 후방감압과 기기사용 후방 추체간 유합술로 치료한 21명을 대상으로 하여 임상적으로는 감염의 치유(CRP정상화 시점)과 재활을 조사하였다. 방사선학적으로는 유합을 얻은 시점과 시상면 선열을 조사하였다. 결과: 감염은 재발 없이 모두 성공적으로 치유되었고 금속기기의 파절도 없었다. 전예에서 술 후 6개월 이내에 추체 간 유합을 얻을 수 있었다. CRP의 정상화 시점은 술 후 평균 28.7 (10-64)이었다. 보행은 술 후 평균 5.8일(2-19)에 시작되었다. 시상면 각도는 술 전 전만 12.3도에서 술후 16.4도로 개선되었다가 최종 추시 상 전만 11도로 감소하였다. 최종 추시 상 시상면 선열은 대부분 술 전 상태와 유사하였다. 결론: 후방감압 및 기기사용 추체 간 유합술은 임상적 및 방사선학적으로 양호한 결과를 보임으로써 요추의 화농성 척추염의 치료에 있어서 효과적인 방법으로 생각되었다.

Keywords

Acknowledgement

Supported by : 충북대학교

References

  1. Kim YM, Won JH, Seo JB, Choi ES, Lee HS, Um SM. Pyogenic L4-5 spondylitis managed with percutaneous drainage followed by posterior lumbar interbody fusion: a case report. J Korean Soc Spine Surg. 2001;8:513-9. https://doi.org/10.4184/jkss.2001.8.4.513
  2. Hibbs RA. A further consideration of an operation for Pott's disease of the spine; with report of cases from the service of the New York orthopaedic hospital. Ann Surg. 1912;55:682-8. https://doi.org/10.1097/00000658-191205000-00003
  3. Hodgson AR, Stock FE. Anterior spinal fusion a preliminary communication on the radical treatment of Pott's disease and Pott's paraplegia. Br J Surg. 1956;44:266-75. https://doi.org/10.1002/bjs.18004418508
  4. Moon MS, Woo YK, Ok IY, et al. Posterior instrumentation for treatment of active dorsolumbar tuberculosis with kyphosis. J Korean Orthop Assoc. 1989;24:660-5.
  5. Cho DY, Kim EH, Koh ES, Cho KN. A comparative study of anterior interbody fusion with and without anterior instrumentation in multi-level tuberculosis of thoraco-lumbar spine. J Korean Orthop Assoc. 1995;30:298-306.
  6. Chung YK, Kim SW, Han HM, Lee EJ, Choi SJ, Chang JD. The results of the surgical treatment using posterior spinal instrumentation for tuberculous spondylitis. J Korean Soc Spine Surg. 1999;6:81-8.
  7. Buyukbebeci O, Karakurum G, Guleç A, Erbgci A. Tubeculous osteomyelitis of the lumbosacral region: a spinal epidural abscess with presacral extension. Arch Orthop Trauma Surg. 2004;124:346-8. https://doi.org/10.1007/s00402-004-0660-y
  8. Chen WJ, Wu CC, Jung CH, Chen LH, Niu CC, Lai PL. Combined anterior and posterior surgeries in the treatment of spinal tuberculous spondylitis. Clin Orthop Relat Res. 2002; 398:50-9. https://doi.org/10.1097/00003086-200205000-00008
  9. Kim DJ, Yun YH, Moon SH, Riew KD. Posterior instrumentation using compresive laminar hooks and anterior interbody arthrodesis for the treatment of tuberculosis of the lower lumbar spine. Spine (Phila Pa 1976). 2004;29:E275-9. https://doi.org/10.1097/01.BRS.0000129027.68574.06
  10. Park JT, Ahn GY, Kim HG, Seong YH. Th e result of anterior fusion with anterior instrumentation in spinal tuberculosis. J Korean Soc Spine Surg. 1996;3:217-24.
  11. Klockner C, Valencia R. Sagittal alignment after anterior debridement and fusion with or without additional posterior instrumentation in the treatment of pyogenic and tuberculous spondylodiscitis. Spine (Phila Pa 1976). 2003;28:1036-42.
  12. Guven O, Kumano K, Yalcin S, Karahan M, Tsuji S. A single stage posterior approach and rigid fixation for preventing kyphosis in the treatment of spinal tuberculosis. Spine (Phila Pa 1976). 1994;19:1039-43. https://doi.org/10.1097/00007632-199405000-00007
  13. Sundararaj GD, Behera S, Ravi V, Venkatesh K, Cherian VM, Lee V. Role of posterior stabilization in the management of tuberculosis of the dorsal and lumbar spine. J Bone Joint Surg Br, 2003;85:100-6. https://doi.org/10.1302/0301-620X.85B1.13300
  14. Park WW, Park YS, Cheon SJ, Jung JY. Posterior lumbar interbody fusion in the pyogenic discitis. J Korean Spine Surg, 2001;8:39-45. https://doi.org/10.4184/jkss.2001.8.1.39
  15. Conterton JW, Irvin RT, Cheng KJ. Th e bacterial glycocalyx in nature and disease. Ann Rev Microbial. 1981;35:299-324. https://doi.org/10.1146/annurev.mi.35.100181.001503
  16. Oga M, Arizono T, Takasita M, Sukioka Y. Eavaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study. Spine (Phila Pa 1976). 1993;18:1890-4. https://doi.org/10.1097/00007632-199310000-00028
  17. Eysel P, Hopf C, Vogel I, Rompe JD. Primary stable an terior instrumentation or dorsoventral spondylodesis in spondylodisicitis? Results of a comparative study. Eur Spine J. 1997; 6:152-7. https://doi.org/10.1007/BF01301428

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