[Spondylodiscitis - an interdisciplinary challenge].
METHODS
A 21-year-old man presented with severe lumbar back pain and progressive paraparesis with clinical signs of spondylitis. Laboratory findings revealed elevated infectious parameters. Because of a positive Mantoux-Test he had been treated with quadruple tuberculostatic drugs for eight weeks without prior identification of the causative pathogen.


METHODS
Magnetic resonance imaging of the spine revealed a multisegmental spondylitis of the lumbar vertebrae (L3 - L5) with epidural empyema. Computed tomography (CT) of the abdomen confirmed large bilateral abscesses in the psoas muscles.


METHODS
The findings supported the diagnosis of spondylitis. The antibiotic regimen was continued. CT-guided drainage was placed in both psoas muscles. Laminectoma of L3 - 5 and dorsal spondylodesis of L2 - S1 were performed immediately. Mycobacterium tuberculosis was cultured from the intraoperative biopsies and treated according to the drug sensitivity test. After further surgical debridment and corporectomy of L4 and L5 the infection was successfully treated. Ten weeks after admission the patient was transferred to a neurologic rehabilitation unit for mobilization.


CONCLUSIONS
Spondylodiscitis treatment is complex and requires a multidisciplinary approach.
Klinik und Poliklinik für Orthopädie und Unfallchirurgie der Universität zu Köln. kourosh.zarghooni@uk-koeln.de
K
K
Zarghooni
M
M
Röllinghoff
J
J
Siewe
G
G
Fätkenheuer
H
H
Seifert
P
P
Eysel
R
R
Sobottke
D000995:Antitubercular Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003646:Debridement; D003937:Diagnosis, Differential; D015299:Discitis / Q000175:diagnosis* / Q000601:surgery; D004322:Drainage; D054242:Emigrants and Immigrants; D004653:Empyema / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D010348:Patient Care Team; D016659:Psoas Abscess / Q000175:diagnosis / Q000601:surgery; D013123:Spinal Fusion; D013166:Spondylitis / Q000175:diagnosis* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014399:Tuberculosis, Spinal / Q000175:diagnosis* / Q000601:surgery; D055815:Young Adult
D000995:Antitubercular Agents