Diagnosis And Treatment Of Pyogenic Spondylitis

Objective To explore the characteristics of diagnosis and treatment for Pyogenic spondylitis.Methods27cases of Pyogenic spondylitis treated January2009to October2014Were retrospectively reviewed. There were18males and9females, aging from32to77years, with an average of57.7years. The average delayed diagnosis time was4.5months (range,4weeks to12months). Of these,15had underlying diseases such as diabetes mellitus, urinary infection, chronic renal insufficiency, hypertension, chronic hepatitis, and the use of corticosteroids. The pain in the lumbar area was early in the beginning, and there was no redness and swelling, but the pain on deep pressure and percussion, the spinal movement was limited.10patients had severe pain, the temperature was above38.5℃in15patients, and the symptoms from compression of the spinal cord was occurred in12patients. But cauda equina without being damaged, the sphincter function remmined normal. The white cell count, ESR, CRP, X-ray and MR imaging were analyzed. All percent had elevated erythroeyte sedimentation rates. The CRP increased at different degree in25patients. The white cell count of6patients increased (10×109/L). The blood culture was taken in15cases and5cases was positive, the positive rates were33%. Seven patients were treated with immobilization and intravenous antibiotic drugs,20patients treated with surgery. Among them18patients using staged anterior debridement and2patients using staged posterior debridement and Bone grafting with iliac crest or rib strut. Anterior spinal instrumentation in7patients, posterior instrumentation wag placed in9patients.Results ALL the27patients were available at final follow-up. The mean duration was2year and3months(ranged from5months to5years). Among these7conservative patients,3patients were free of symptoms,2patient had slight back pain,2patient had chronic severe back pain. Among20patients who underwent Operative Treatment,17patients were free of symptoms,3had slight back pain, their infections had no recurrence and all obtained bone unionr. The duration for bone union ranged from12to24weeks, with all average of18weeks.Conclusion Because of the non-specific nature of the symptoms at presentation, Pyogenic spondylitis is usually not recognized at an early stage, and the misdiagnosis rate can be up to37.04%(10/27). ESR and CRP are more sensitive indexes than the white cell count for monitoring the prognosis of Pyogenic spondylitis. The treatments include conservative treatment and operation treatment. Conservative treatment time is too long, the effect of anti-infection treatment is low, easy to leave symptoms of low back pain, and can not prevent the occurrence of spinal deformity. Howere, Surgical management can eliminate the infection thoroughly for short recovery and good for improving back pain, use internal fixation properly can increase spinal stability, prevent the shiaing of bone graft, avoid kphosis. So we should take operation treatment more after rule out of the surgery contraindications.