The use of external fixation for the treatment of spine infection with Actinomyces bacillus.
OBJECTIVE
External fixation can be used for stabilization of the spine in salvage cases, especially in cases of infection of the spine. The advantages of this method are avoiding the needs for internal fixation devices and for postoperative bracing. The literature on this is scant. Reported is a rare case of osteomyelitis of the D2 vertebra with an epidural abscess caused by Actinomyces israelii that spread from the lung and was treated by decompression and external fixation.


METHODS
A 51-year-old man with right upper lobe pneumonia due to A. israelii coccobacillus developed osteomyelitis of the D2 vertebra and an epidural abscess with a gradual paraparesis. He underwent a laminectomy of D1-D3 and 3 weeks later stabilization of the upper thoracic spine using a tubular external fixator that was inserted from C7-D1 to D3-D4. The patient was treated with antibiotic intravenously and later orally. After 2 months, the external fixator was removed.


RESULTS
At the last follow-up, the patient had no fever, the erythrocyte sedimentation rate and C-reactive protein level had normal values, and there was only a slight limitation in the range of motion of the cervical paraparesis. Radiography and magnetic resonance imaging demonstrated stabilization of the affected segment without any sign of active osteomyelitis. There were no complications associated with the use of the external fixator.


CONCLUSIONS
The use of external fixation offers an appropriate alternative for stabilization of the spine as a salvage procedure. The procedure could be performed easily and without any major complications. Especially for the treatment of complicated cases of spinal infection, the use of an external fixator can be of great benefit.
Fenichel
Itay
I
Spine Deformity Unit, Orthopaedic Department, Sheba (Tel-Hashomer) Medical Center, Ramat-Gan, Israel. itay-f@zahav.net.il
Caspi
Israel
I
D000196:Actinomycosis / Q000601:surgery*; D001799:Blood Sedimentation; D015897:Comorbidity; D003664:Decompression; D020802:Epidural Abscess / Q000175:diagnosis; D016267:External Fixators; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000382:microbiology* / Q000601:surgery*; D011014:Pneumonia / Q000453:epidemiology / Q000382:microbiology; D013117:Spinal Cord Compression / Q000175:diagnosis; D013122:Spinal Diseases / Q000382:microbiology* / Q000601:surgery*; D013131:Spine / Q000382:microbiology