Fig. 23.1
(a, b) Preoperative plain film demonstrated a collapsed in L2–3 disc space with a loss of end plate; (c, d) preoperative MRI showed the destruction of L2–3 intervertebral disc and end plate with low signal intensity in T1-weighted images, but mixed signal intensity in T2-weighted images; (e) preoperative CT scan indicated partial destruction of the L2 and L3 vertebral body; (f) intraoperative X-ray showed the XLIF cage was inserted into L2–3 disc space through the working channel; (g) intraoperative X-ray showed the lateral screw-rod fixation; (h) the operation of lateral screw-rod fixation; (i, j) postoperative X-ray demonstrated the satisfactory position of the implants; (k, l) 2 years after surgery, the CT scan indicated solid bony fusion in L2–3 disc space
23.5.2 Case 2
A 25-year-old woman presented with progressive low-back pain for 2 years and continued to get worse accompanied with limitation of activity. No fever or night sweats were detected. Considering the physical examination, tenderness and percussion pain around the L1–2 spinal process were reported, while the mobility of the lumbar spine was detected. VAS score for back pain was 7 points. Blood samples revealed neither leukocytosis nor abnormity in ESR and CRP. Considering the possibility of spinal tuberculosis, antituberculous treatment consisted of isoniazid, rifampin, pyrazinamide, and ethambutol is given to these patients for about 2 weeks. And then, we debrided psoas abscess and adjacent vertebral bodies of L1–2. Then the bone graft that harvested from the iliac crest was inserted into the diseased disc space followed by posterior percutaneous pedicle screw fixation. The pathology report supported the diagnosis of tuberculosis infection. With 2 weeks of continuous antituberculous treatment and intravenous levofloxacin, the patient recovered well and wore brace during the rehabilitation training. The VAS score of low-back pain decreased to 1 point 1 week after surgery. Blood samples revealed no abnormity when she discharged from hospital (Fig. 23.2).
Fig. 23.2
(a, b) Preoperative dynamic X-ray demonstrated the instability and collapse of L1–2 intervertebral space with a loss of endplate; (c, d) preoperative CT scan showed the destruction of vertebral body and the giant psoas abscess on the right side; (e) intraoperative X-ray of the XLIF working channel; (f) lesions debrided from the L1–2 intervertebral space; (g) intraoperative lateral X-ray showed the position of posterior percutaneous pedicle screw fixation; (h, i) postoperative X-ray indicated the satisfactory position of the implants; (j) postoperative axial image of CT scan showed the bone graft; (k, l) postoperative CT scan demonstrated the decreased size of psoas abscess and satisfactory position of the bone graft; (m, n) 1 year after surgery, the X-ray demonstrated a solid bony fusion at L1–2 level, while the internal fixation were posited well; (o, p) 1 year after surgery, the CT scan indicated new bone formation peripherally around the structural graft in the previously infected disc space, while psoas abscess was eliminated thoroughly
Further Reading
1.
Garg RK, Somvanshi DS. Spinal tuberculosis: a review. J Spinal Cord Med. 2011;34:440–54.CrossRefPubMedPubMedCentral
2.
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Verdu-Lopez F, Vanaclocha-Vanaclocha V, Gozalbes-Esterelles L, Sanchez-Pardo M. Minimally invasive spine surgery in spinal infections. J Neurosurg Sci. 2014;58:45–56.PubMed
6.
Fushimi K, Miyamoto K, Fukuta S, Hosoe H, Masuda T, Shimizu K. The surgical treatment of pyogenic spondylitis using posterior instrumentation without anterior debridement. J Bone Joint Surg (Br). 2012;94:821–4.CrossRef
7.
Cebrian Parra JL, Saez-Arenillas Martin A, Urda Martinez-Aedo AL, Soler Ivanez I, Agreda E, Lopez-Duran Stern L. Management of infectious discitis. Outcome in one hundred and eight patients in a university hospital. Int Orthop. 2012;36:239–44.CrossRefPubMedPubMedCentral
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