Ciosek Timothy A, Sørlie Andreas, Munch-Ellingsen Jens, Solberg Tore K, Weum Sven, de Weerd Louis
From the Department of Plastic and Reconstructive Surgery, University Hospital of North Norway, Tromsø, Norway.
Dermatoplastic Imaging Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Plast Reconstr Surg Glob Open. 2024 May 24;12(5):e5837. doi: 10.1097/GOX.0000000000005837. eCollection 2024 May.
Acute cervical osteomyelitis due to an epidural abscess and pyogenic spondylodiscitis in an immunosuppressed patient with progressive myelopathy is a challenge for the reconstructive surgeon. This report presents our novel approach to treat such a condition in a 56-year-old patient in whom antibiotic treatment and decompression of the medulla by laminectomy of C4-C6 failed. Under general anesthesia, debridement of all infected tissue, including anterior corpectomy of C4-C6, was performed. Simultaneously, a free vascularized fibula graft (FVFG) was harvested, adapted to the bone defect, and anastomosed to the superior thyroid artery and external jugular vein. The graft was stabilized with an anterior plate. A scheduled posterior stabilization was performed 1 week later. was cultured from bone samples and was treated with antibiotics. The postoperative course was uncomplicated besides a dorsal midline defect 6 weeks postoperatively that was closed with a sensate midline-based perforator flap. Five years on, the patient is infection free, and regular control computed tomography and magnetic resonance imaging scan images show progressive fusion and hypertrophy of the fibula to C3/C7 vertebrae. An FVFG combined with posterior stabilization could be a promising primary salvage procedure in cases with progressive myelopathy caused by acute cervical osteomyelitis due to spinal infection. The FVFG contributes to blood circulation, delivery of antibiotics, and an immunological response to the infected wound bed and can stimulate rapid fusion and hypertrophy over time.
一名免疫功能低下且患有进行性脊髓病的患者，因硬膜外脓肿和化脓性脊椎间盘炎引发急性颈椎骨髓炎，这对重建外科医生来说是一项挑战。本报告介绍了我们针对一名56岁患者治疗此类病症的新方法，该患者接受抗生素治疗以及C4 - C6椎板切除术减压髓质均告失败。在全身麻醉下，对所有感染组织进行清创，包括C4 - C6椎体次全切除术。同时，获取带血管蒂游离腓骨移植体（FVFG），使其适配骨缺损，并与甲状腺上动脉和颈外静脉吻合。移植体用前路钢板固定。1周后进行预定的后路稳定手术。从骨样本中培养出病菌并给予抗生素治疗。术后过程顺利，仅术后6周出现一个背侧中线缺损，采用基于中线的感觉皮瓣进行修复。5年后，患者无感染，定期的计算机断层扫描和磁共振成像扫描图像显示腓骨与C3/C7椎体逐渐融合且肥大。对于因脊柱感染导致急性颈椎骨髓炎并伴有进行性脊髓病的病例，FVFG联合后路稳定术可能是一种有前景的一期挽救手术。FVFG有助于血液循环、抗生素输送以及对感染创面床的免疫反应，并且随着时间推移可刺激快速融合和肥大。
