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Maki Y, Fukaya K. Two-Stage Cervical and Thoracic-Lumbar-Sacral Circumferential Fixation for Pyogenic Spondylitis: A Case Report. Cureus 2024; 16:e53070. [PMID: 38410351 PMCID: PMC10896660 DOI: 10.7759/cureus.53070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/28/2024] Open
Abstract
Pyogenic spondylitis is a rare life-threatening condition. Conservative treatment with antibiotics is indicated; however, surgery can be considered in refractory cases. The surgical strategy varies, as pyogenic spondylosis can occur from the cervical to sacral regions. To our knowledge, although there is less invasiveness as an advantage in the following management, cervical and thoracic-lumbar-sacral circumferential fixations in two sessions for pyogenic spondylitis have not been previously described. An 84-year-old man complained of ambulation disturbances and pain in the neck and upper and lower extremities (the Japan Orthopaedic Association cervical myelopathy evaluation questionnaire score of 5/17). Magnetic resonance imaging revealed pyogenic spondylitis of the cervical, thoracic, and lumbar regions. Epidural abscesses and spondylodiscitis were concurrently diagnosed with multi-level skipping lesions from the cervical to the sacral regions. As these lesions were resistant to antibiotic treatment and the neurological symptoms worsened, surgical treatment was planned. Anterior cervical discectomy and fusion, and posterior cervical fixation were followed by oblique and posterior lumbar intervertebral fusions with long-level fixation from T12 to the ilium using percutaneous pedicle screws. The surgeries were performed in two sessions to avoid the invasiveness of surgeries in a single session. The patient's condition improved after a second surgery. The patient was discharged on postoperative day 116. No recurrence was observed for six months, and the patient was able to ambulate independently. Two-stage cervical and thoracic-lumbar-sacral circumferential fixation for pyogenic spondylitis contributed to a favorable outcome (the Japan Orthopaedic Association cervical myelopathy evaluation questionnaire score of 13/17).
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Affiliation(s)
- Yoshinori Maki
- Neurosurgery, Hikone Chuo Hospital, Hikone, JPN
- Rehabilitation, Hikari Hospital, Otsu, JPN
| | - Kenji Fukaya
- Neurosurgery, Ayabe Renaiss Hospital, Ayabe, JPN
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Ohyama S, Inoue M, Toshi N, Okuyama K, Tokeshi S, Suzuki N, Shiga Y, Inage K, Yawara E, Orita S, Ohtori S. Retroperitoneal Continuous Local Antibiotic Perfusion for Refractory Pyogenic Vertebral Osteomyelitis: A Case Report. Cureus 2023; 15:e50636. [PMID: 38226091 PMCID: PMC10789547 DOI: 10.7759/cureus.50636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/17/2024] Open
Abstract
Pyogenic vertebral osteomyelitis (PVO) is a prevalent infection in the elderly, frequently complicated by iliopsoas and epidural abscesses. Traditional treatments are often ineffective for refractory cases. In this report, a 76-year-old man with PVO, iliopsoas, and epidural abscess was unresponsive to antibiotics, presenting with severe lower back pain and functional impairments. A two-stage surgical intervention was implemented: anterior debridement, autogenous bone graft fixation, and novel application of retroperitoneal continuous local antibiotic perfusion (CLAP), followed by posterior fixation. A contrast test verified correct CLAP perfusion into the iliopsoas abscess and intervertebral disc space. Substantial improvements were noted postoperatively, including a marked reduction in pain, inflammation, and the size of both abscesses. In conclusion, this case demonstrates the feasibility and effectiveness of retroperitoneal CLAP in treating refractory PVO, offering a potential innovative solution for cases resistant to conventional therapies.
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Affiliation(s)
- Shuhei Ohyama
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Masahiro Inoue
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Noriyasu Toshi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Kohei Okuyama
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Soichiro Tokeshi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Noritaka Suzuki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Yasuhiro Shiga
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Kazuhide Inage
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Eguchi Yawara
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
- Department of Orthopedic Surgery, Center for Frontier Medical Engineering, Chiba University, Chiba, JPN
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
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