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Rigid Posterior Lumbopelvic Fixation without Formal Debridement for Pyogenic Vertebral Diskitis and Osteomyelitis Involving the Lumbosacral Junction: Technical Report.

Mazur MD, Ravindra VM, Dailey AT, McEvoy S, Schmidt MH - Front Surg (2015)

Bottom Line: Technical report.We describe the management of PVDO at the lumbosacral junction in which the infection invaded the endplates, disk space, vertebrae, prevertebral soft tissues, and epidural space.At 2-year follow-up, successful fusion and eradication of the infection were achieved.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah , Salt Lake City, UT , USA.

ABSTRACT

Background: Pelvic fixation with S2-alar-iliac (S2AI) screws can increase the rigidity of a lumbosacral construct, which may promote bone healing, improve antibiotic delivery to infected tissues, and avoid L5-S1 pseudarthrosis.

Purpose: To describe the use of single-stage posterior fixation without debridement for the treatment of pyogenic vertebral diskitis and osteomyelitis (PVDO) at the lumbosacral junction.

Study design: Technical report.

Methods: We describe the management of PVDO at the lumbosacral junction in which the infection invaded the endplates, disk space, vertebrae, prevertebral soft tissues, and epidural space. Pedicle involvement precluded screw fixation at L5. Surgical management consisted of a single-stage posterior operation with rigid lumbopelvic fixation augmented with S2-alar-iliac screws and without formal debridement of the infected area, followed by long-term antibiotic treatment.

Results: At 2-year follow-up, successful fusion and eradication of the infection were achieved.

Conclusion: PVDO at the lumbosacral junction may be treated successfully using rigid posterior-only fixation without formal debridement combined with antibiotic therapy.

No MeSH data available.


Related in: MedlinePlus

Patient 1. A 67-year-old woman with severe back pain presented after medical treatment of a polymicrobial sacral decubitus ulcer. Sagittal T1-weighted magnetic resonance images of the lumbar spine with (A) and without (B) contrast demonstrated PVDO at L4–L5–S1 with involvement of the vertebral bodies and endplates. L4–L5 spondylodiscitis with anterolisthesis was present as well as epidural and prevertebral abscesses. Preoperative upright radiographs before (C) and 1 month after (D) antibiotic therapy demonstrate progression from Grade I to Grade II L4–L5 anterolisthesis. Posterior-only decompression and fusion without formal debridement of the infected tissues was performed with pedicle screws at L2, L3, right L4, and S1 combined with S2AI screws (E,F); poor bone quality precluded instrumentation at L4 on the left and at L5. At 2 years, sagittal (G) and coronal (H) CT reconstructions demonstrate stable fusion at the lumbosacral junction.
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Figure 1: Patient 1. A 67-year-old woman with severe back pain presented after medical treatment of a polymicrobial sacral decubitus ulcer. Sagittal T1-weighted magnetic resonance images of the lumbar spine with (A) and without (B) contrast demonstrated PVDO at L4–L5–S1 with involvement of the vertebral bodies and endplates. L4–L5 spondylodiscitis with anterolisthesis was present as well as epidural and prevertebral abscesses. Preoperative upright radiographs before (C) and 1 month after (D) antibiotic therapy demonstrate progression from Grade I to Grade II L4–L5 anterolisthesis. Posterior-only decompression and fusion without formal debridement of the infected tissues was performed with pedicle screws at L2, L3, right L4, and S1 combined with S2AI screws (E,F); poor bone quality precluded instrumentation at L4 on the left and at L5. At 2 years, sagittal (G) and coronal (H) CT reconstructions demonstrate stable fusion at the lumbosacral junction.

Mentions: Imaging demonstrated PVDO of L4–L5–S1 with endplate erosion, L4–L5 spondylodiscitis with anterolisthesis, and collapse of the L4–L5 and L5–S1 disk spaces (Figure 1). The infection extended into the epidural and prevertebral regions, and there was progression of L4–L5 anterolisthesis despite medical treatment.


Rigid Posterior Lumbopelvic Fixation without Formal Debridement for Pyogenic Vertebral Diskitis and Osteomyelitis Involving the Lumbosacral Junction: Technical Report.

Mazur MD, Ravindra VM, Dailey AT, McEvoy S, Schmidt MH - Front Surg (2015)

Patient 1. A 67-year-old woman with severe back pain presented after medical treatment of a polymicrobial sacral decubitus ulcer. Sagittal T1-weighted magnetic resonance images of the lumbar spine with (A) and without (B) contrast demonstrated PVDO at L4–L5–S1 with involvement of the vertebral bodies and endplates. L4–L5 spondylodiscitis with anterolisthesis was present as well as epidural and prevertebral abscesses. Preoperative upright radiographs before (C) and 1 month after (D) antibiotic therapy demonstrate progression from Grade I to Grade II L4–L5 anterolisthesis. Posterior-only decompression and fusion without formal debridement of the infected tissues was performed with pedicle screws at L2, L3, right L4, and S1 combined with S2AI screws (E,F); poor bone quality precluded instrumentation at L4 on the left and at L5. At 2 years, sagittal (G) and coronal (H) CT reconstructions demonstrate stable fusion at the lumbosacral junction.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4585130&req=5

Figure 1: Patient 1. A 67-year-old woman with severe back pain presented after medical treatment of a polymicrobial sacral decubitus ulcer. Sagittal T1-weighted magnetic resonance images of the lumbar spine with (A) and without (B) contrast demonstrated PVDO at L4–L5–S1 with involvement of the vertebral bodies and endplates. L4–L5 spondylodiscitis with anterolisthesis was present as well as epidural and prevertebral abscesses. Preoperative upright radiographs before (C) and 1 month after (D) antibiotic therapy demonstrate progression from Grade I to Grade II L4–L5 anterolisthesis. Posterior-only decompression and fusion without formal debridement of the infected tissues was performed with pedicle screws at L2, L3, right L4, and S1 combined with S2AI screws (E,F); poor bone quality precluded instrumentation at L4 on the left and at L5. At 2 years, sagittal (G) and coronal (H) CT reconstructions demonstrate stable fusion at the lumbosacral junction.
Mentions: Imaging demonstrated PVDO of L4–L5–S1 with endplate erosion, L4–L5 spondylodiscitis with anterolisthesis, and collapse of the L4–L5 and L5–S1 disk spaces (Figure 1). The infection extended into the epidural and prevertebral regions, and there was progression of L4–L5 anterolisthesis despite medical treatment.

Bottom Line: Technical report.We describe the management of PVDO at the lumbosacral junction in which the infection invaded the endplates, disk space, vertebrae, prevertebral soft tissues, and epidural space.At 2-year follow-up, successful fusion and eradication of the infection were achieved.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah , Salt Lake City, UT , USA.

ABSTRACT

Background: Pelvic fixation with S2-alar-iliac (S2AI) screws can increase the rigidity of a lumbosacral construct, which may promote bone healing, improve antibiotic delivery to infected tissues, and avoid L5-S1 pseudarthrosis.

Purpose: To describe the use of single-stage posterior fixation without debridement for the treatment of pyogenic vertebral diskitis and osteomyelitis (PVDO) at the lumbosacral junction.

Study design: Technical report.

Methods: We describe the management of PVDO at the lumbosacral junction in which the infection invaded the endplates, disk space, vertebrae, prevertebral soft tissues, and epidural space. Pedicle involvement precluded screw fixation at L5. Surgical management consisted of a single-stage posterior operation with rigid lumbopelvic fixation augmented with S2-alar-iliac screws and without formal debridement of the infected area, followed by long-term antibiotic treatment.

Results: At 2-year follow-up, successful fusion and eradication of the infection were achieved.

Conclusion: PVDO at the lumbosacral junction may be treated successfully using rigid posterior-only fixation without formal debridement combined with antibiotic therapy.

No MeSH data available.


Related in: MedlinePlus