Osteomyelitis of the Spine Following Prostatic Surgery

Abstract

Vertebral osteomyelitis following prostatectomy has been described previously, but little mention of the condition is made in the radiological literature. Although a rare complication of prostatic surgery, osteomyelitis of the spine is a debilitating condition in the early diagnosis of which the radiologist may be of aid if he is alert to its possibility. Among a large number of radiologists questioned personally, however, none could recall having seen a single case. To previously reported cases, the following examples of osteomyelitis following prostatic surgery are added. Case I: E. B., a 70-year-old male, was admitted to the hospital with a ten-year history of progressive frequency and difficulty in urinating. Urinalysis revealed 2 white cells and uric acid crystals. The red blood cell count was 3,700,000, hemoglobin 13.4 gm., white blood cell count 10,800, with a normal differential. A first-stage suprapubic prostatectomy was performed on Oct. 22, 1950. The bladder was found to be hypertrophied and the prostate bulged at the base. A mushroom catheter was left in place. A second-stage suprapubic prostatectomy was performed on Oct. 30. The prostate was freed from its bed and removed, and a Pilcher bag was inserted for hemostasis. On microscopic examination, glandular and interstitial hyperplasia, chronic inflammation, and obliterative end-arteritis were found. The patient experienced a chill on the first postoperative day, accompanied by an elevation of temperature to 103° F., with a return to normal the following day. After an uneventful recovery, he was discharged on Nov. 4. He was readmitted for a few hours on Dec. 1 and given 500 c.c. of whole blood. Laboratory studies revealed 4,300,000 red blood cells and 14,500 white cells. The patient was admitted for the third time on Dec. 11. At this time he complained of excruciating pain of one week duration, “coming in waves” in the lumbar area. There was marked tenderness, with muscle spasm and rigidity at the left costovertebral angle. An x-ray examination of the lumbar spine made upon admission was negative. Spinal fluid study revealed clear fluid, pressure of 160 mm. of water, total protein 45 mg. per cent. The urine contained 20 to 30 white cells and bacteria. The white cell count was 11,300, with a normal differential, sedimentation rate 60 and index 50, acid phosphatase 1.5 units. Temperature on admission was 101° F., becoming normal on the next day and remaining so thereafter. The patient received penicillin, 1,600,000 units intramuscularly per day for forty-five days, with a one week interruption after the first month. Aureomycin, 1,500 mg., was given for fourteen days. Demerol, 100 mg., was given whenever necessary, and 10 mg. of morphine sulfate every six hours for twelve days, with no relief initially.