PRIMARY PYOGENIC OSTEOMYELITIS OF THE ARTICULAR PROCESSES OF THE VERTEBRAE REPORT OF AN UNUSUAL CASE

The occurrence of pyogenic osteomyelitis of the vertebral column is considered to be relatively rare when compared with the incidence of the same disease in the other bones of the body, especially in the long bones. However, when we consider the milder and more benign types, as well as the better recognized acute types, and make allowance for the many un-recognized cases, it will be found that the condition is not so very rare. The usual conception of osteomyelitis of the spine is that of a severe acute inflammation, often with cord involvement and nerve complications. The recent progress made in roentgenographic technique and diagnosis has brought to light many cases of the milder and more chronic variety, referred to as the “ benign form “ 21, 30, 33 with or without abscess formation. Clinically these may be mistaken for other conditions giving pain in the back, such as rheumatism, arthritis, referred visceral pain, etc. In the early stages of inflammation there are no definite roentgenographic find-ings, but soon alterations in the bone structure become manifest. The earliest report on osteomyelitis of the spine was made by Lanne-longue ‘ in 1879. Subsequent reports on the subject appeared by Hahn in 1895 and 1899. Of a series of 661 cases compiled by him from two European clinics, small and irregular bones were involved in fifty-one and the vertebrae in only one. At the Mount Sinai Hospital in New York City, an incidence of 1.5 per cent. of osteomyelitis of the spine is reported in a series of osteomye-litis of all bones. Kulowski ‘ reports 3.94 per cent. of osteomyelitis of the spine in a series of 1500 cases of pyogenic osteomyelitis of bones from the University Hospitals, Iowa City. In a series of 193 cases of osteomye-litis of all bones admitted to the American University Hospital, Beirut, Syria, there was one case in which the fourth and fifth lumbar vertebrae were involved, and a second case of possible involvement of the sacrum in a patient who had numerous foci of the disease in several other bones. The case reported in this article is not included in the series mentioned