Abstract
Pyogenic spondylitis is a challenging condition that requires early and accurate diagnosis for appropriate treatment. Most cases can be treated non-surgically or with minimally invasive surgical procedures; however, a combination of anterior debridement/bone grafting and posterior fixation is necessary for severe cases. We encountered a case of lumbar pyogenic spondylitis treated with anterior debridement and autogenous bone grafting after percutaneous endoscopic discectomy drainage (PEDD) with percutaneous pedicle screw (PPS) fixation. The continuous pus oozing from the PEDD drainage tube wound was characteristic in this case, and the pus was considered to be caused by secondary infection/microbial substitution. The discharge immediately stopped and healed after anterior debridement and autogenous bone grafting. Escherichia coli was first detected as the causative bacterium, and Corynebacterium amycolatum and Corynebacterium striatum were detected as the cause of secondary infection/microbial substitution. The possibility of secondary infection/microbial substitution should be considered when the clinical course worsens.
Highlights
Pyogenic spondylitis (PS) is a challenging condition; immediate and accurate diagnosis followed by appropriate treatment are essential
PS can be treated with non-surgical procedures or minimally invasive surgical procedures; a combination of anterior debridement/bone grafting and posterior fixation is necessary for severe cases
We performed anterior debridement and autogenous bone grafting to L3/4 at 64 days after admission using the retroperitoneal approach because the focus of the secondary infection was considered to be located in the L3/4 disc space and the vertebral body of L3 and L4 (Figures 7, 8)
Summary
Pyogenic spondylitis (PS) is a challenging condition; immediate and accurate diagnosis followed by appropriate treatment are essential. We performed anterior debridement and autogenous bone grafting to L3/4 at 64 days after admission using the retroperitoneal approach because the focus of the secondary infection was considered to be located in the L3/4 disc space and the vertebral body of L3 and L4 (Figures 7, 8). At the follow-up at 12 months after final surgery, the infection did not recur, CRP level stays negative, no spinal instrument failure/loosening and bone union around the autogenous bone graft were observed by CT scans, and the patient does not complain of any symptoms (Figures 1, 9). The study was performed in accordance with the Declaration of Helsinki and within the appropriate ethical framework
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