- 期刊
椎間盤感染引起背痛：個案報告
Low Back Pain Due to Infective Discitis: A Case Report
摘要
因椎間盤感染所引發背痛者並不常見，背痛病史中若發現有危險因子則應懷疑椎間盤感染，如有過久的下背痛、年紀大、其他感染、糖尿病或近期動過手術等危險因子，再加上發炎指數持續性上升，就應該把椎間盤感染納入鑑別診斷。磁振造影用於診斷椎間盤感染的敏感性很高。椎間盤感染的治療主要是抗生素治療，治療無效才應考慮開刀。 本個案報告為一位66歲男性病患，下背痛伴有雙側大腿麻痛長達三年，腰部磁振造影顯示L4/L5脊椎狹窄，因而接受L4/L5椎板切除術及L4/L5椎間盤軟骨切除術，術後因傷口感染再接受清創重建手術。但手術後，病患仍覺下背痛，且越來越嚴重，手術部位傷口外觀清潔，僅發現發炎指數CRP及ESR上升。進一步追蹤磁振造影顯示L4/L5椎間盤感染，隨即接受L3-L5椎板切除術及內固定，同時給予抗生素治療。術後病患恢復狀況良好，可以緩慢步行不需攙扶。
並列摘要
Infective discitis accompanying low back pain is uncommon. In general, risk factors for infective discitis include an age greater than 50 years, a history of cancer, unexplained weight loss, pain that lasts more than 1 month, a history of intravenous drug abuse, presence of a urinary tract infection or other infections, diabetes mellitus, and recent invasive procedures. The presence of an elevated erythrocyte sedimentation rate (ESR) and a C-reactive protein (CRP) level have proven to be reliable laboratory criteria consistent with infective discitis. Moreover, magnetic resonance (MR) imaging findings have been shown to have a good sensitivity for infective discitis. Antibiotics are considered the first line of treatment; however, if conservative treatment fails, surgery remains an option. We present herein a 66-year-old male patient who had low back pain with bilateral sciatica for 3 years. A lumbar spine MR image showed L4/L5 spinal stenosis. The patient underwent a L4/L5 laminectomy and a L4/L5 discectomy, then debridement for a wound infection. Progressive low back pain persisted in spite of a clean wound. Laboratory data showed a high CRP and ESR and repeat lumber spine MR imaging revealed L4/L5 infective discitis. Further treatment included a L3-L5 laminectomy, with internal fixation and administration of antibiotics. Postoperatively, the patient could walk independently for short distances with a slow gait.
延伸閱讀
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