경피적 요추 배농술로 치유한 Staphylococcus aureus 요추 골수염 1예

Abstract

Pyogenic vertebral osteomyelitis is a relatively rare condition but its incidence is recently increasing due to common use of intravenous access devices and resultant nosocomial bacteremia. Its predisposing factors include old age, diabetes mellitus, immunocompromised states, drug addiction, oral steroid therapy, dialysis, and previous vertebral degenerating changes. Because of incidious and bizarre clinical presentation in old ages, there is usually a considerable delay in diagnosis, resulting in neurologic complications. Therefore, early diagnosis is critical in obviating complications. In addition, management of the disease is not uniform and is controversial regarding the role of surgery and duration to antibiotics.

We report a case of relapsed methicillin sensitive Staphylococcus aureus vertebral osteomyelitis cured by percutaneous drainage and intravenous antibiotics. The 55-year-old woman was admitted to our hospital because of high fever, severe low back pain, and limited motion of right lower extrimity for 1 week. She was diagnosed as a pyogenic vertebral osteomyelitis based on combinations of spine magnetic resonance imaging, bone scan and positive blood culture for methicillin sensitive S. aureus. She was treated with intravenous antibiotics for a total of 5 weeks but high fever and limited motion of right hip joint were relapsed. Therefore, she was managed with percutaneous lumbar drainage for 9 days, and then high fever and low back pain wre gradually subsided, and flexion contracture of right hip joint was disappeared promptly.

At present the role of aspiration and drainage to involved spines is not well-known in pyogenic vertebral osteomyelitis. But, in this case, it brought prompt and marked symptomatic recovery. Further study is needed to confirm this result.