Department of Otolaryngology-Head and Neck Surgery, Kettering Medical Center, United States of America.
Boonshoft School of Medicine, Wright State University, United States of America.
Am J Otolaryngol. 2022 Mar-Apr;43(2):103310. doi: 10.1016/j.amjoto.2021.103310. Epub 2021 Dec 3.
Cervical vertebral osteomyelitis (CVO) is a complex destructive pathology that presents as a significant challenge to reconstructive surgeons. Advanced cases of CVO involving neurologic deficits, spinal column instability, or refractory infection require surgical intervention with bony debridement and decompression followed by spinal reconstruction, realignment, and stabilization. Reconstruction of the spine is typically performed through an anterior approach with or without posterior instrumentation. Restoration of the anterior spinal column can be performed with titanium or PEEK cages, allograft bone or vascularized autograft bone. Anterior spine reconstruction using vascularized osseous free flaps has been well documented in the medical literature; however, to our knowledge, we report the largest osteomyelitic anterior cervical spine defect that has been reconstructed using a single strut osseous free flap. This was a complex case of cervical osteomyelitis in a patient with prior C4-C7 anterior cervical corpectomy and fusion who presented with instrumentation failure and septicemia. Anterior column reconstruction required a vascularized fibular strut spanning six vertebral levels from C3-T1, as well as a trapezius myocutaneous pedicled flap for posterior soft tissue coverage.
颈椎骨髓炎（CVO）是一种复杂的破坏性病理，对重建外科医生来说是一个重大的挑战。涉及神经功能缺损、脊柱不稳定或难治性感染的 CVO 晚期病例需要进行手术干预，包括骨清创和减压，然后进行脊柱重建、矫正和稳定。脊柱重建通常通过前路进行，可同时或不进行后路器械固定。钛或 PEEK cage、同种异体骨或带血管自体骨可用于重建前脊柱柱。使用带血管游离骨瓣进行前路脊柱重建在医学文献中有详细记载；然而，据我们所知，我们报告了使用单个支柱骨游离瓣重建的最大颈椎骨髓炎前颈椎缺损病例。这是一例复杂的颈椎骨髓炎病例，患者曾行 C4-C7 前路颈椎椎体切除术和融合术，现出现器械失败和败血症。前柱重建需要一个血管化腓骨支柱，跨越 C3-T1 六个椎体水平，以及一个斜方肌肌皮瓣用于后部软组织覆盖。
