Management of candidal vertebral osteomyelitis - Report of six cases
Journal
Journal of Musculoskeletal Research
Journal Volume
12
Journal Issue
4
Pages
225-232
Date Issued
2009
Author(s)
Abstract
From September 1994 to April 2001, we treated six cases of Candida spondylitis (five patients by surgery, and one by conservative approach). The age ranged from 16 to 60 years old. Four were men, and two women. The patients were associated with the following underlying diseases: one with renal failure, one with rheumatic heart with valve replacement, one with drug addiction, one apparently healthy patient, and two patients with leukemia. Because five patients had suffered from severe and persistent low back pain and had neurological deficits, anterior approach to debride the infected vertebral focus and strut bone grafting was performed. Additional posterior implant placement was performed in two cases, and anterior instrumentation in one case for further stabilization. Fluconazole was supplementary to amphotericin B in three patients. The other three patients received fluconazole. One patient had double spinal lesions one in the lumbar, while the other in the thoracic T910 level caused paraplegia. Staged operation was performed, starting from lumbar and followed by operating over the thoracic lesion. Infection was under control, but the patient had partial neurological recovery (Frankel D). He died 54 months later due to poor general conditions, recurrent bacterial sepsis and pneumonia. In other five patients, infection was well under control and without neurological sequel. The treatment principles of Candida spinal infection are similar to those of pyogenic spondylitis. Anterior debridement of the infective focus and bone grafting are beneficial in controlling infection and achieving stable healing. Posterior instrumentation can be applied for further stabilization without compromising the control of Candida infection. Fluconazole was effective in treating Candida spondylitis, and it must be prescribed after surgery. ? 2009 World Scientific Publishing Company.
SDGs
Other Subjects
amphotericin B; fluconazole; adolescent; adult; article; bone graft; bone transplantation; Candida spondylitis; candidiasis; clinical article; conservative treatment; death; debridement; disease association; disease severity; drug dependence; drug efficacy; drug substitution; female; human; infection control; kidney failure; leukemia; low back pain; lumbar spine; male; neurologic disease; orthopedic equipment; paraplegia; pneumonia; rheumatic heart disease; sepsis; spine stabilization; spine surgery; spondylitis; surgical approach; surgical technique; thoracic spine; treatment duration
Type
journal article