Case Reports
doi: 10.3389/fsurg.2022.974931.
eCollection 2022.
Affiliations
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Case Reports
Front Surg.
.
Abstract
Brucella spondylitis (BS) is a specific spinal infection. Surgical treatment is required for Brucella spondylitis that has caused neurological symptoms in the lower extremities and developed an intraspinal abscess. The main purpose of surgery is to remove the lesion and restore the stability of the spine. However, both the anterior approach and the posterior approach cannot completely remove the lesions, resulting in a low cure rate and a certain recurrence rate. Although anterior or posterior debridement is more thorough, it is unbearable for some patients with poor general condition. In this study, for the first time, a negative pressure wound therapy (NPWT) device was introduced into the intervertebral space through the extreme lateral approach to treat a patient with Brucella spondylitis. We summarize the treatment process, and discuss the feasibility and effectiveness of this surgical approach through 1-year follow-up.
Keywords:
brucella spondylitis; extreme lateral interbody fusion (XLIF); negative pressure wound therapy (NPWT); spinal infection; vacuum sealing drainage (VSD).
© 2022 Cui, Chang and Yu.
Conflict of interest statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Figures
Figure 1
A 40-year-old man with Brucella lumbar infection and bilateral isthmus of the L5 vertebral body. (A) Plain x-ray shows degeneration of the lumbar spine, with a slight narrowing of the L4/5 intervertebral space and bilateral isthmus rupture at L5. (B) CT showed “worm-eaten-like” bone destruction in the L4 and L5 vertebral bodies, and L5 lumbar spondylolysis. (C) MRI showed abnormal signal in the L4/5 vertebral body and space, and the formation of abscess in the spinal canal.
Figure 2
Lumbar lesion debridement + VSD drainage through the extreme lateral approach. (A) Locate and mark the body surface (there is a problem with the marking time, and the re-examination is less than 1 year). (B) Schematic of VSD placement. (C) After separation of the psoas major muscle, the C-arm fluoroscopy was performed again to determine the gap, and the channel and distraction device were installed. (D) The VSD sponge was trimmed and placed in the intervertebral space, and another VSD sponge was covered on the body surface.
Figure 3
The third stage of iliac bone grafting and internal fixation. (A–C) During the operation, the iliac bone block was taken from the original incision, placed in the intervertebral space, and then fixed with a self-designed lateral lumbar spine plate. (D) X-ray and (E) MRI were reviewed 1 week after operation, showing that the internal fixation was well in place and the abscess in the spinal canal disappeared.
Figure 4
12 months postoperatively. X-rays (A,B), CT (C), and MRI (D) showed that the internal fixation position was good, the bone graft was fused, and the abnormal signals in the lumbar vertebral body, spinal canal, and psoas major muscle had disappeared.
References