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Surgical aspects of nonspecific inflammatory and suppurative disease of the vertebral column

1966; Elsevier BV; Volume: 112; Issue: 2 Linguagem: Inglês

10.1016/0002-9610(66)90024-9

1879-1883

W. Eugene Stern, R. E. Balch,

Spinal Dysraphism and Malformations

Nonspecific suppuration involving the spinal column has protean manifestations and may mimic other disease entities. It may require surgical treatment because of one or more of several indications. It is serious in its implications and requires the combined efforts of the neurosurgeon, the orthopedist, and those with expertise in antibiotic therapy. Intervertebral space infections sequential to the surgical treatment of herniating disc disease constitutes one category. The presumed hematogenous spread of infection to the vertebral column without antecedent operation on the spine constitutes another. Three examples of the first category point up the principles to be observed in the management of postoperative wound infections after operations for herniating intervertebral disc disease. Five examples of the second category, all involving the thoracic spine, illustrate the surgical challenges of severe local thoracic pain, deep tissue suppuration, nerve root compression, spinal cord compression, and collapse of the vertebral column with instability. The Staph. aureus bacterium is the most frequent offending organism. Laminography is the most useful early diagnostic radiologic tool. Surgical treatment involves the paravertebral evacuation of localized suppuration, spinal cord and nerve root decompression, and the removal of infected posterior perineural bony elements with preservation of the integrity of the column of vertebral bodies. In the face of local wound infection, wide saucerization is usually required. The eight cases analyzed herein demonstrate the difficulties of clinical and radiologic diagnoses which lead to delays in the initiation of optimal management including general supportive and antibacterial therapy.