Titanium Posterior Lateral Mass Plating in the Treatment of an Unstable Infected Cervical Spine: Case Report

鈦金屬側體骨板在頸椎脊髓炎的應用：個案報告

陳旭照(Shiu-Jau Chen) ； 陳敏弘(Ming-Hong Chen) ； 邱建才(Chien-Tsai Chiu)

《Formosan Journal of Surgery》 36卷6期 (2003/12) Pp. 279-284

摘要

頸椎脊髓炎若造成神經壓迫或變形不穩定，需進行清創減壓及融合手術。內固定的選擇是一大難題，有人主張在感染處置放內固定物，會使感染難以控制，因此主張使用外固定即可。有人則持相反的看法，認為內固定物反而會使骨頭獲得更佳的融合，減少日後頸椎變形的機率，縮短治療的期間 • 本文提出一位第三與第四節頸椎脊髓炎的病患，患者頸椎嚴重疼痛變形，且有神經壓迫的症狀。經過了前側清創融合、後側側體骨板固定、與抗生素治療後順利出院。側體骨釘骨板，為頸椎後固定物中穩定度最佳者。與前側骨板相較之下，後側側體骨板可避免與感染源直接接觸，在若干病患可減少內固定的節數。欽金屬材質更有利於術後的磁振攝影追蹤，實為此類頸椎感染病患的最佳選擇。

並列摘要

Posterior lateral mass screws and plates are widely used to stabilize an unstable cervical spine in cases of trauma, postlaminectomy instability, and neoplasm. However, its use in cervical osteomyelitis has rarely been discussed in the literature. Placement of a foreign body in an area of osteomyelitis, though not absolutely contraindicated, may make control of the infection more difficult. Posterior fixation is a method of immobilizing the spine that avoids direct contact with the infected focus. We report a case of C3-4 osteomyelitis with epidural abscess treated by anterior partial corpectomy for debridement and posterior lateral mass plating, followed by six weeks of antibiotics. Because the plates and screws were made of titanium, we were able to perform postoperative MR imaging to evaluate the infection. The patient’s osteomyelitis resolved completely and she had good bone fusion.

並列關鍵字

spinal osteomyelitis ； lateral mass screw ； cervical spine ； spinal instru-mentation ； lateral mass plating