化膿性脊椎炎78例の検討

Clinical Aspects of Pyogenic Spondylitis in 78 Cases

　抄録：当科で経験した化膿性脊椎炎78例について検討した．1973年4月～1987年12月までを前半期，1988年1月から2002年4月までを後半期として比較すると，後半期の化膿性脊椎炎の臨床像として，患者の高齢化，いわゆるcompromised hostの増加，急性症状を呈さない症例の増加，起因菌（特に弱毒菌）の多様化が特徴的であった．手術適応は前半期：1）脊髄症状の合併，2）X線像で骨破壊が進行しアライメント不良を生じたもの，3）明らかな膿瘍が存在するもの，の3つであったが，後半期は6～8週の保存療法に抵抗する症例にも積極的に手術を行った．この手術適応の拡大により，化膿性脊椎炎全体の平均治療期間は有意には短縮されなかった．しかし，病巣の掻爬と骨移植が的確に行われれば，化学療法の期間短縮が可能であり，腰椎罹患例においては腰痛の遺残を予防できる可能性があることが示された．

　We reviewed the clinical features and outcome in 78 cases of pyogenic spondylitis (PS) treated in our institution since 1973. In the early period (EP：1973 to 1987), the surgical indications for PS were 1）neurological deficits, 2）vertebral collapse with abnormality of the spinal alignment, and 3）abscess formation. In the late period (LP：1988 to 2002), we extended the surgical indications to include：4）cases resistant to conservative therapy for 6 weeks. We compared the clinical features and outcome of the groups treated during the two periods. In the LP, there were twice as many patients with PS and their average age was 10 years older than in the FP. There were more immunocompromised hosts and more gram-negative organisms were isolated in the LP. The six weeks limit on conservative therapy was applied in 6 of the 21 cases operated in the LP. However, our modification of the surgical indications did not shorten the period of antibiotic therapy in the cases as a whole, partly because of changes in the characteristics of patient population.D uring the LP, cases operated on by the anterior approach required a shorter period of postoperative antibiotic therapy (28.0±11.6 days) than the cases operated on by the posterior approach (75.2±10.5 days, p＜0.01). Our preliminary data showed that surgical intervention in PS cases refractory to 6 weeks of conservative therapy resulted in less residual low back pain, than in the EP. hese results appear to support the validity of our surgical indications in the LP.