Abstract
Proximal junctional failure (PJF) is one of the most devastating complications that develop after adult spinal deformity (ASD) surgery. Here, we report 2 rare cases of PJF accompanied by delayed infection after ASD surgery with a review of the relevant literatures. Late-onset infection is an infrequent complication despite acute postoperative infection is common after posterior spinal instrumentation and fusion. Among them, delayed onset pyogenic spondylitis of the adjacent vertebra to the instrumented vertebrae is an extremely rare phenomenon. We do not have a clear explanation for this pathology. Since the delayed infections developed not in the fused segments but in the adjacent vertebra, the cause of the first case can be speculated as stimulation of low-virulent organisms to fester and hematogenous seeding and that of the second case as metal fretting and a sterile inflammatory response causing hematogenous microbial seeding, respectively. Additional studies on this phenomenon are warranted to elucidate the pathogenesis of this complication.
Highlights
Proximal junctional failure (PJF) is one of the most devastating complications that occur after adult spinal deformity (ASD) surgery [1,2,3]
Since methicillin-resistant Staphylococcus aureus (MRSA) was detected by both spine and knee cultures, vancomycin and cefazolin were continuously administered for 76 days after admission, when both the white blood cell count (WBC) and C-reactive protein (CRP) levels returned to normal
In the present study, considering the timing of the onset of spondylitis, it can be estimated that our cases were not surgical site infections but rather secondary infections that occurred after proximal junctional kyphosis (PJK)
Summary
Proximal junctional failure (PJF) is one of the most devastating complications that occur after adult spinal deformity (ASD) surgery [1,2,3]. Since methicillin-resistant Staphylococcus aureus (MRSA) was detected by both spine and knee cultures, vancomycin and cefazolin were continuously administered for 76 days after admission, when both the WBC and CRP levels returned to normal. A 76-year-old female underwent PSF (Th10-ilium) for Schwab-SRS type L ASD (Figures 2(a) and 2(b)), the postoperative course was fine at the beginning, and we had kept follow-up at the outpatient clinic She was readmitted to our hospital due to high fever and bilateral motor weakness 13 months after surgery (Figures 2(d)–2(g)). Based on bacterial culture and drug sensitivity test, teicoplanin was continuously administered for 55 days after admission when the CRP level became normal She gradually recovered motor function (Figure 2(c))
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