Abstract
IntroductionOnly ten cases of primary pyogenic spondylitis following vertebroplasty have been reported in the literature. To the best of our knowledge, we present the first reported case of primary pyogenic spondylitis and spondylodiscitis caused by kyphoplasty.Case presentationA 72-year old Caucasian man with an osteoporotic compression fracture of the first lumbar vertebra after kyphoplasty developed sensory incomplete paraplegia below the first lumbar vertebra. This was caused by myelon compression following pyogenic spondylitis with a psoas abscess. Computed tomography guided aspiration of the abscess cavity yielded group C Streptococcus. The psoas abscess was percutaneously drained and laminectomy and posterior instrumentation with an internal fixator from the eleventh thoracic vertebra to the fourth lumbar vertebra was performed. In a second operation, corpectomy of the first lumbar vertebra with cement removal and fusion from the twelfth thoracic vertebra to the second lumbar vertebra with a titanium cage was performed. Six weeks postoperatively, the patient was pain free with no neurologic deficits or signs of infection.ConclusionPyogenic spondylitis is an extremely rare complication after kyphoplasty. When these patients develop recurrent back pain postoperatively, the diagnosis of pyogenic spondylitis must be considered.
Highlights
Ten cases of primary pyogenic spondylitis following vertebroplasty have been reported in the literature
magnetic resonance imaging (MRI) revealed first lumbar vertebra (L1) spondylitis with a right-sided psoas abscess and compression of the lumbar spinal cord (Figure 3). These findings were consistent with a diagnosis of pyogenic spondylitis of the L1 vertebra after kyphoplasty
One patient with pyogenic spondylitis of twelfth thoracic vertebra (T12) following eleventh thoracic vertebra (T11) vertebroplasty was treated with drainage at T12 and subsequent vertebroplasty using antibiotic cement [8]
Summary
Vertebroplasty and kyphoplasty are discussed critically in the literature [1,2,3,4,5,6]. MRI revealed L1 spondylitis with a right-sided psoas abscess and compression of the lumbar spinal cord (Figure 3). These findings were consistent with a diagnosis of pyogenic spondylitis of the L1 vertebra after kyphoplasty. The patient was transferred to the inpatient rehabilitation unit after 11 days He made an uneventful recovery and his back pain improved significantly (VAS 3). His neurological symptoms regressed after six weeks, with normal biochemistry and no signs of ongoing inflammation. At discharge, his pain was a VAS 2; six months later, he was symptom free and completely ambulatory without assistance (Figure 4). Plain radiographs demonstrated no pseudarthrosis or dislocation of screws, rods or the cage (Figure 4)
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