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Intensivmedizin up2date 2013; 09(04): 317-328
DOI: 10.1055/s-0033-1358893
Neuro-Intensivmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Epidurale Abszesse und Spondylodiszitis

Jürgen Piek
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Publication Date:
13 November 2013 (online)

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Kernaussagen

  • Eine Spondylitis ist eine von den Grund- und Deckplatten ausgehende bakterielle Entzündung des Wirbelkörpers. Bei der Spondylodiszitis ist zusätzlich die Bandscheibe betroffen.

  • Beim akuten Verlauf kommt es zu einer schweren Allgemeininfektion mit starken Schmerzen im betroffenen Wirbelsegment, rasch zunehmenden neurologischen Defiziten und ausgeprägten Veränderungen der Entzündungsparameter im Laborbefund.

  • Beim chronischen Verlauf fehlen klinische Zeichen einer Allgemeininfektion meist, neurologische Defizite treten erst im weit fortgeschrittenen Stadium auf und die laborchemischen Veränderungen sind gering ausgeprägt.

  • Patienten mit spinaler Infektion und allgemeinen Zeichen der Sepsis bedürfen einer umgehenden intensivmedizinischen Behandlung.

  • Patienten ohne Sepsis, neurologisches Defizit oder intraspinales Empyem behandelt man konservativ mit einer i. v. Antibiose und anschließender oraler Fortführung.

  • Bei neurologischen Defiziten mit morphologischer Ursache, Wirbelkörperdeformität oder einem Versagen der konservativen Behandlung ist eine operative Therapie indiziert (Debridement, Defektfüllung, Stabilisierung).

 

  • Literatur

  • 1 Calderone RR, Larsen JM. Overview and classification of spinal infections. Orthop Clin North Am 1996; 27: 1-8
    PubMedGoogle Scholar
  • 2 Pott P. Remarks on that kind of palsy of the lower limbs which is frequently found to accompany a curvature of the spine. London: J. Johnson; 1779
    Google Scholar
  • 3 Hadjipavlou AG et al. Hematogenous pyogenic spinal infections and their surgical management. Spine 2000; 25: 1668-1679
    CrossrefPubMedGoogle Scholar
  • 4 Hopf C et al. Operative treatment of spondylodiscitis – what is the most effective approach?. Neurosurg Rev 1998; 21: 217-225
    CrossrefPubMedGoogle Scholar
  • 5 Kilani B et al. Bacterial spondylodiskitis: pyogenic or tuberculous?. Ann Med Interne (Paris) 2001; 152: 236-241
    PubMedGoogle Scholar
  • 6 Mann S et al. Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients. Neurosurg Focus 2004; 17: E3
    PubMedGoogle Scholar
  • 7 Sobottke R et al. Current diagnosis and treatment of spondylodiscitis. Dtsch Arztebl Int 2008; 105: 181-187
    PubMedGoogle Scholar
  • 8 Chen WH, Jiang LS, Dai LY. Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation. Eur Spine J 2007; 16: 1307-1316
    CrossrefPubMedGoogle Scholar
  • 9 Pola E et al. Medical and surgical treatment of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci 2012; 16 : 35-49
    PubMedGoogle Scholar
  • 10 Wiwatworapan T, Anantasetagoon T. Extra-pulmonary tuberculosis at a regional hospital in Thailand. Southeast Asian J Trop Med Public Health 2008; 39: 521-525
    PubMedGoogle Scholar
  • 11 Hopkinson N, Stevenson J, Benjamin S. A case ascertainment study of septic discitis: clinical, microbiological and radiological features. QJM 2001; 94: 465-470
    CrossrefPubMedGoogle Scholar
  • 12 Belzunegui J et al. Haematogenous vertebral osteomyelitis in the elderly. Clin Rheumatol 2000; 19: 344-347
    CrossrefPubMedGoogle Scholar
  • 13 Flamme CH et al. MRI in spondylitis and spondylodiscitis. Orthopade 2001; 30: 514-518
    CrossrefPubMedGoogle Scholar
  • 14 Rath SA et al. Neurosurgical management of thoracic and lumbar vertebral osteomyelitis and discitis in adults: a review of 43 consecutive surgically treated patients. Neurosurgery 1996; 38: 926-933
    CrossrefPubMedGoogle Scholar
  • 15 Rohde V et al. Spondylodiscitis after lumbar discectomy. Incidence and a proposal for prophylaxis. . Spine (Phila Pa 1976) 1998; 23: 615-620
    CrossrefPubMedGoogle Scholar
  • 16 Mastronardi L et al. Spondylodiscitis after lumbar microdiscectomy: effectiveness of two protocols of intraoperative antibiotic prophylaxis in 1167 cases. Neurosurg Rev 2005; 28: 303-307
    CrossrefPubMedGoogle Scholar
  • 17 Belzunegui J et al. Vertebral osteomyelitis in northern Spain. Report of 62 cases. . Clin Exp Rheumatol 1999; 17: 447-452
    PubMedGoogle Scholar
  • 18 Cusmano F et al. Radiologic diagnosis of spondylodiscitis: role of magnetic resonance. Radiol Med 2000; 100: 112-119
    PubMedGoogle Scholar
  • 19 Diehn FE. Imaging of spine infection. Radiol Clin North Am 2012; 50: 777-798
    CrossrefPubMedGoogle Scholar
  • 20 Leone A et al. Imaging of spondylodiscitis. Eur Rev Med Pharmacol Sci 2012; 16 (Suppl. 02) 8-19
    PubMedGoogle Scholar
  • 21 Nanni C et al. FDG PET/CT is useful for the interim evaluation of response to therapy in patients affected by haematogenous spondylodiscitis. Eur J Nucl Med Mol Imaging 2012; 39: 1538-1544
    CrossrefPubMedGoogle Scholar
  • 22 Treglia G et al. The role of nuclear medicine in the diagnosis of spondylodiscitis. Eur Rev Med Pharmacol Sci 2012; 16 : 20-25
    PubMedGoogle Scholar
  • 23 Cotty P et al. Vertebral osteomyelitis: value of percutaneous biopsy. 30 cases. J Neuroradiol 1988; 15: 13-21
    PubMedGoogle Scholar
  • 24 Hitchon PW et al. Spinal infections. Clin Neurosurg 1992; 38: 373-387
    PubMedGoogle Scholar
  • 25 Osenbach RK, Hitchon PW, Menezes AH. Diagnosis and management of pyogenic vertebral osteomyelitis in adults. Surg Neurol 1990; 33: 266-275
    CrossrefPubMedGoogle Scholar
  • 26 Bone RC et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Crit Care Med. Chest 1992; 101: 1644-1655
    PubMedGoogle Scholar
  • 27 Bone RC et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 2009; 136 (05) e28
    CrossrefPubMedGoogle Scholar
  • 28 Hempelmann RG, Mauer UM. Eitrige Erkrankungen der Wirbelsäule. In: Börm W, Meyer F, eds. Spinale Neurochirurgie. Stuttgart: Schattauer; 2009: 199-208
    Google Scholar
  • 29 Eysel P et al. Primary stable anterior instrumentation or dorsoventral spondylodesis in spondylodiscitis? Results of a comparative study. Eur Spine 1997; 6: 152-157
    CrossrefPubMedGoogle Scholar
  • 30 Faraj AA, Webb JK. Spinal instrumentation for primary pyogenic infection report of 31 patients. Acta Orthop Belg 2000; 66: 242-247
    PubMedGoogle Scholar
  • 31 Flamme CH, Frischalowski T, Gosse F. Possibilities and limits of conservative therapy of spondylitis and spondylodiscitis. Z Rheumatol 2000; 59: 233-239
    CrossrefPubMedGoogle Scholar
  • 32 Legrand E et al. Management of nontuberculous infectious discitis. treatments used in 110 patients admitted to 12 teaching hospitals in France. Joint Bone Spine 2001; 68: 504-509
    CrossrefPubMedGoogle Scholar