Pyogenic spondylitis presenting with skip lesions.
We report on a 65-year-old man who presented with a 1-month history of aggravating backache and low-grade fever. He suddenly became paraplegic (Frankel B). Muscle power was grade 0 approximately 1 over the bilateral lower limbs. X-ray films showed disc space narrowing and end-plate blurring at the T9 approximately T11 and L4 approximately L5 levels. Magnetic resonance imaging showed an infectious lesion at T9 approximately T11 and another at L4 approximately L5. An emergent operation was performed under the impression of pyogenic spondylitis with spinal cord compression. The patient showed a significant recovery (Frankel D) after the thoracic and lumbar spinal surgeries. Pyogenic spondylitis usually presents as a vertebra-disc-vertebra lesion spreads to the contiguous vertebra-disc-vertebra unit. The current patient had pyogenic spondylitis with coexistent thoracic and lumbar lesions. This kind of skip lesion is common in spinal malignant metastasis, but rare in spinal infections. Awareness of the possibility of multiple lesions or skip lesions will facilitate the diagnosis and treatment of this condition.
Lai
Po-Liang
PL
Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taipei.
Leu
Hsieh-Shong
HS
Niu
Chi-Chien
CC
Chen
Wen-Jer
WJ
Chen
Lih-Huei
LH
D000368:Aged; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D013166:Spondylitis / Q000473:pathology*; D013203:Staphylococcal Infections / Q000473:pathology*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013904:Thoracic Vertebrae / Q000473:pathology*