Percutaneous drainage and continuous irrigation in patients with severe pyogenic spondylitis, abscess formation, and marked bone destruction.
OBJECTIVE
The use of percutaneous suction aspiration has recently become viewed as an effective management strategy for pyogenic spondylitis unresponsive to conservative treatment. What remains unclear is whether it can be effective for severe pyogenic spondylitis in which abscess formation or marked bone destruction is present. The authors undertook a study to clarify answers to this question.


METHODS
The authors evaluated clinical and radiographic/neuroimaging data obtained in five patients with severe pyogenic spondylitis, extensive abscesses, and marked bone destruction. These patients had undergone percutaneous drainage and continuous irrigation because open surgery was considered contraindicated in light of their poor general health. The mean period during which continuous irrigation was applied was 9 days (range 7-11 days), and the mean period during which the drainage tube was in place was 19 days (range 13-38 days). All patients suffered from back pain, which was relieved by the percutaneous technique in four patients after a mean of 8 days. The abscesses and inflammation resolved in all patients. Progressive osseous destruction was not observed, and open surgery was performed in only one patient in whom back pain persisted as a result of spinal instability.


CONCLUSIONS
After an unsuccessful course of conservative treatment, severe pyogenic spondylitis with abscess formation or marked bone destruction was successfully treated using percutaneous drainage and continuous irrigation. Based on their results, the authors believe that this procedure can be used in patients with severe pyogenic spondylitis that was unresponsive to conservative treatment, particularly in those whose general health is poor.
Hanaoka
Naoyoshi
N
Department of Orthopedic Surgery, Oita Nakamura Hospital, Japan. ubucya@hotmail.com
Kawasaki
Yoshiteru
Y
Sakai
Toshinori
T
Nakamura
Taro
T
Nanamori
Kazuhisa
K
Nakamura
Eijiro
E
Uchida
Ken
K
Yamada
Hidehiro
H
D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000175:diagnosis / Q000628:therapy*; D001442:Bacteroides Infections / Q000175:diagnosis / Q000628:therapy; D001441:Bacteroides fragilis; D020802:Epidural Abscess / Q000175:diagnosis / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D016106:Methicillin Resistance; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000628:therapy; D016659:Psoas Abscess / Q000175:diagnosis / Q000628:therapy; D013166:Spondylitis / Q000175:diagnosis / Q000628:therapy*; D013169:Spondylolysis / Q000175:diagnosis / Q000628:therapy*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000628:therapy; D013396:Suction; D007507:Therapeutic Irrigation; D016896:Treatment Outcome