Iwami Takuro, Yagi Mitsuru, Okada Eijiro, Suzuki Satoshi, Nori Satoshi, Tsuji Osahiko, Nagoshi Narihito, Watanabe Kota, Fujita Nobuyuki, Nakamura Masaya, Matsumoto Morio
Department of Orthopedic Surgery, Keio University School of Medicine, Japan.
Department of Orthopedic Surgery, Fujita Health University, Japan.
Case Rep Orthop. 2020 Jul 10;2020:8883828. doi: 10.1155/2020/8883828. eCollection 2020.
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.
近端交界性失败（PJF）是成人脊柱畸形（ASD）手术后发生的最具破坏性的并发症之一。在此，我们报告2例ASD手术后发生PJF并伴有延迟感染的罕见病例，并对相关文献进行综述。尽管后路脊柱内固定融合术后急性感染很常见，但迟发性感染是一种罕见的并发症。其中，器械固定椎体相邻椎体的迟发性化脓性脊柱炎是一种极其罕见的现象。我们对这种病理情况尚无明确解释。由于延迟感染并非发生在融合节段，而是在相邻椎体，推测第一例的原因是低毒力微生物刺激化脓和血行播散，第二例的原因分别是金属微动和无菌性炎症反应导致血行性微生物播散。有必要对这一现象进行更多研究以阐明这种并发症的发病机制。
