Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Hachioji, Tokyo, Japan.
Department of General Internal Medicine, Tokai University Hospital, Tokai University School of Medicine, Shimo Kasuya, Isehara-shi, Kanagawa, Japan.
Diagn Interv Radiol. 2021 Mar;27(2):269-271. doi: 10.5152/dir.2021.20189.
A 79-year-old man was admitted to our hospital with C6-C7 pyogenic spondylodiscitis with an epidural abscess. Since the cervical intervertebral space is narrower than the thoracolumbar intervertebral space, drain insertion into the cervical intervertebral space requires a more accurate procedure. Moreover, the specific anatomy of cervical vertebrae, which includes the transverse foramen through which the vertebral artery passes and the uncinate process on the side edges of the top surface of the bodies, makes it impossible to perform computed tomography (CT)-guided percutaneous intervertebral drain insertion through the posterolateral approach. Therefore, CT fluoroscopy-guided percutaneous cervical intervertebral drain insertion using a lateral approach, in which the needle is advanced between the carotid sheath and scalene muscle, and simultaneous intravenous contrast enhancement might be a safe and useful technique. There have been no papers on CT fluoroscopy-guided percutaneous intervertebral drain insertion for cervical pyogenic spondylodiscitis, while successful CT fluoroscopy-guided percutaneous intervertebral drain insertion for thoracolumbar pyogenic spondylodiscitis has been reported. Here, we successfully performed CT fluoroscopy-guided percutaneous intervertebral drain insertion for cervical pyogenic spondylodiscitis.
一位 79 岁男性因 C6-C7 化脓性脊椎炎合并硬膜外脓肿而入院。由于颈椎椎间孔比胸腰椎椎间孔狭窄,因此需要更精确的程序将引流管插入颈椎椎间孔。此外,颈椎的具体解剖结构包括通过椎动脉的横突孔和椎体顶部边缘的钩突,这使得无法通过后外侧入路进行 CT 引导下经皮椎间引流插入。因此,使用侧入路的 CT 透视引导下经皮颈椎椎间引流插入,针在颈动脉鞘和斜角肌之间推进,并同时进行静脉内对比增强可能是一种安全有效的技术。目前尚无关于 CT 透视引导下经皮颈椎化脓性脊椎炎引流的论文,而成功的 CT 透视引导下经皮胸腰椎化脓性脊椎炎引流已有报道。在这里,我们成功地进行了 CT 透视引导下经皮颈椎化脓性脊椎炎引流。