一期的手術を施行した環軸椎亜脱臼を伴った環軸椎骨髄炎の 1 例

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We reported a case of atlantoaxial osteomyelitis accompanied by atlantoaxial dislocation that was treated through transoral debridement and posterior fusion in one-stage surgery. On October 22, 1998, a 72-year-old man with chronic pulmonary fibrosis and old myocardial infarction was admitted to a hospital with high fever. During that hospitalization, cefotax was administered intravenously, and on October 30, 1998, his condition deteriorated rapidly resulting in tetraplegia. Lateral roentgenograms of the cervical spine indicated atlantoaxial dislocation and cervical CT revealed a destructive lesion of the odontoid process and of the adjacent anterior portion of the atlas and occipital condyles. MRI demonstrated a cystic mass lesion dorsal to the odontoid process compressing the upper cervical spinal cord. On the same day the patient was transferred to our institution and a halo vest was applied. Transoral needle biopsies of the body of the axis were performed on November 6 and 20 and the cultures of the biopsy specimens were negative. Because of the increasing in mass size on MRI, transoral debridement and decompression, and posterior fusion from the occiput to the third cervical vertebra in one-stage surgery were performed on December 2, 1998. The histological finding of the surgical specimen was chronic inflammation. Two months after the operation the halo vest was removed and intravenous administration of antibiotics was continued until February 5, 1999. Three months after the operation, he recovered the ability to walk and was transferred to another hospital for rehabilitation. The patient was asymptomatic at the six-month follow-up examination, and the neuroimaging studies disclosed consolidation of the fusion with no further evidence of the inflammatory process. In conclusion a combined anterior-posterior procedure in one-stage surgery seems to be a useful and effective method for obtaining anterior decompression and solid posterior fusion in atlantoaxial osteomyelitis.
日本脊髄外科学会の論文
1999-11-30

一期的手術を施行した環軸椎亜脱臼を伴った環軸椎骨髄炎の 1 例

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