Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Charcot Spinal Arthropathy with Extensive Vertebral Body Destruction and Cerebrospinal Fluid Collection: A Case Report Mimicking Infective Spondylitis

척추체의 광범위한 파괴와 뇌척수액 축적이 동반된 샤르코 척추 관절병증: 감염성 척추염과 유사한 소견을 보이는 증례보고

  • Cho, Kyu-Jung (Department of Orthopedic Surgery, College of Medicine, Inha University) ;
  • Kim, Yeo-Ju (Department of Radiology, College of Medicine, Inha University) ;
  • Kim, Young-Tae (Department of Orthopedic Surgery, College of Medicine, Inha University) ;
  • Youn, Yung-Hun (Department of Orthopedic Surgery, College of Medicine, Inha University)
  • 조규정 (인하대학교 의과대학 정형외과학교실) ;
  • 김여주 (인하대학교 의과대학 영상의학교실) ;
  • 김영태 (인하대학교 의과대학 정형외과학교실) ;
  • 윤영훈 (인하대학교 의과대학 정형외과학교실)
  • Received : 2019.06.27
  • Accepted : 2019.08.20
  • Published : 2020.08.30
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Abstract

A 68-year-old man presented with a bed sore with pus discharge on lower back. Radiographs showed extensive destruction of the L4 vertebral body. Magnetic resonance imaging (MRI) showed fluid collection with an enhanced wall at the defect of the L4 vertebral body extending into both psoas muscles. The primary diagnosis was neuropathic spondylopathy, but infective spondylitis was not ruled out. Initially, he was treated with antibiotics for two weeks. A follow-up MRI showed no improvement of the abscess, so surgical exploration was done. Charcot spinal arthropathy resulted in extensive vertebral body destruction that may be similar to infectious spondylitis, particularly in the case with fluid accumulation due to rupture of dura.

68세 남자 환자가 허리의 피부에서 고름을 동반한 욕창으로 내원하였다. 초진시 일반 방사선상 제4요추체의 광범위한 파괴 소견과 자기공명영상 촬영에서 제4요추 척추체의 결손 부위에 고인 조영 증강된 많은 양의 액체가 양측 요근 및 후관절까지 확장된 소견을 보였다. 신경병성 척추병증으로 일차 진단하였으나 농양을 동반한 감염성 척추염을 배제할 수 없어 정맥 항생제를 2주 투여하였다. 자기공명영상을 재촬영한 결과 농양의 크기는 줄어 들지 않아 수술적 치료로 진행하였다. 샤르코 척추 관절병증은 광범위한 척추체 파괴를 일으켜 감염성 척추염과 유사한 소견을 보일 수 있으며 특히 척추체 불안정으로 인한 경막 파열로 뇌척수액이 축적되면 감별이 어려울 수 있어 이 증례를 보고하는 바이다.

Keywords

References

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