化膿性頸椎炎の診断と治療—4症例の報告

Cervical Pyogenic Spondylodiscitis : 4 cases report and a review of the literature

I．はじめに

　脊椎感染症は，椎体の感染（vertebral osteo-nlyelitis），椎間板の感染（discitis）にわけられるが，多くは同時に侵されるため，spondylitisあるいはspondylodiscitisと呼ばれる^8,11）．MRIが普及した最近でも高齢化社会の到来に伴って病態は複雑化しており，脊椎炎の診断と治療に迷う機会は，かならずしも減少しているとは思われない^{1-3,6-8,12,14,19）}．脊椎炎の多くは胸腰椎にみられ，頸椎炎は稀である^{1,2,4,8,13,15,19）}．頸椎炎の4例を経験したので，その臨床的特徴，診断，治療方法と最近の脊椎炎における知見について考察する．

We report 4 cases of cervical spondylodiscitis presenting neurological and/or neuroradiological abnorma-lities. Such a lesion is rare in the cervical spine of adults, but should he suspected when the patient hasradiculopathy and/or myelopathy associated with inflammatory signs. We discussed the clinical character-istics and the procedures of the diagnosis and treatment of cervical spondylodiscitis.

Early and definitive diagnosis can be achieved by cervical X-ray, MR imaging and biopsy. It is very im-portant to evaluate the pyogen for the lesion by needle biopsy.

When the patient has the compression of the spinal cord and/or nerve roots and the neurological find-ings of radiculopathy and/or myelopathy, surgical exploration and decompression of the spinal cordand/or nerve roots should he carried out as soon as possible. Anterior debridement and fusion should beperformed using the effective antibiotics. We were able to achieve good prognosis by treatment followingthis procedure of diagnosis in the four cases of cervical spondylodiscitis mentioned.