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Osteomyelitis der Wirbelsäule

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Zusammenfassung

Infektionen der Wirbelsäule kommen selten und eher bei älteren Patienten mit Harnwegsinfekten und Diabetes mellitus vor. Mit der Zunahme von immunsupprimierten Patienten , v. a. bei Drogenabusus oder HIV-Infektion, und von Immigranten aus Ländern der 2. und 3. Welt steigt die Inzidenz von Infektionen an der Wirbelsäule gerade auch bei jüngeren Patienten. Typisch ist nur ein Erreger als Verursacher, mit Staphylococcus aureus als häufigstem bakteriellem Keim. Die Keimbesiedelung erfolgt vornehmlich hämatogen und betrifft initial die endplattennahenAreale des Wirbelkörpers. Bei unspezifischer Klinik sind insbesondere die Kernspintomographie und der mikrobiologische Keimnachweis im Punktat diagnostisch wesentlich. Im Vordergrund der Therapie steht die gezielte Antibiose über mindestens 6–8 Wochen. Eine Indikation zur Op. mit osteosynthetischer Stabilisierung und Spondylodese besteht in der Regel bei neurologischen Ausfällen, knöcherner Instabilität sowie Abszessen.

Abstract

Spinal infections are rare, occurring most often in elderly patients with urinary tract infections or diabetes. With the increasing number of patients with immune suppression, and also the increasing number of immigrants in the population, spinal infections are seen more frequently, especially in young adults. Typically spinal infections are monomicrobial, Staphylococcus aureus being the most common organism. Hematogenous spread of bacteria through the arterial paravertebral collateral vessels into the subchondral bone marrow of the vertebral bodies is the most common source of infection. Clinical presentation is often nonspecific. Important diagnostic measurements are laboratory studies, radiological evaluation including MR image scans, and CT-guided percutaneous biopsy of the lesion for microbiological studies. The management of spinal infections consists of antimicrobial therapy over 6–8 weeks. Surgical intervention is indicated in neurologically compromised patients for spinal instability and abscesses.

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  1. Chirurgische Klinik und Poliklinik der BG-Kliniken Bergmannsheil, Ruhruniversität Bochum

    E. J. Müller, O. J. Russe & G. Muhr

  2. Chirurgische Klinik und Poliklinik der BG-Kliniken Bergmannsheil, Ruhruniversität, Postfach 10 02 50, 44702 , Bochum

    E. J. Müller

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  2. O. J. Russe
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  3. G. Muhr
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Correspondence to E. J. Müller.

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Müller, E.J., Russe, O.J. & Muhr, G. Osteomyelitis der Wirbelsäule. Orthopäde 33, 305–315 (2004). https://doi.org/10.1007/s00132-003-0603-2

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  • DOI: https://doi.org/10.1007/s00132-003-0603-2

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