不安定性を伴う感染性脊椎炎に対するＩｎｓｔｒｕｍｅｎｔａｔｉｏｎの使用経験

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  • Spinal Instrumentation for Lumbar Spine Instabilities after Infections

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For the treatment of lumbar spine instability due to infection, we used spinal instrumentation after control of infection. Treatments for chronic infection in the 2 cases were not altered for the operations.The first patient, a 70-year old woman, had serious low back pain and paresis of lower extremities during sitting and standing. She had already been treated with antibiotics for 1 year under the diagnosis of tuberculosis in lumbar spine. Extensive destruction of L2 and L3 vertebrae, spinal canal compression, and abcesses in the iliopsoas muscle were observed by CT and MRI. The lateral view radiograph showed severe instability at the L2/L3 level in flexion/extension posture. The extrafocal posterior fusion (T12, L1 and L4, L5) with pedicle screw/rod system and anterior decompression with bone graft were performed. Tuberculosis infection was confirmed by PCR. Five months after the operation, she could walk without any support. The second patient, a 72-year old woman, complained of serious low back pain and paresis of left leg. She could not walk because of severe left leg pain persisting for about 1 month. Antibiotics had been administered for three years under the diagnosis of pseudomonas infection. The L5 vertebra was collapsed resulting in serious instability. The spinal canal was compressed by necrotic tissue. The lesion extended to L4 and the sacrum. The extrafocal posterior fusion (L2, L3 and pelvis) with screw/rod system were performed without decompression of the spinal canal. Nine months after the operation, she could walk with a cane.

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