Bingaman Amanda, Gupta Rohan V, Kanuparthi Srinivasa P, Kim Bong-Soo
Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Department of Neurosurgery, Temple University Hospital, Philadelphia, PA, USA.
J Spine Surg. 2025 Jun 27;11(2):363-370. doi: 10.21037/jss-24-133. Epub 2025 Apr 14.
Vertebral osteomyelitis (VO) can cause devastating neurological injury when there is a failure in early identification or prompt initiation of targeted antimicrobial therapy. Surgery is indicated for severe cases, such as those with a pathologic fracture or deformity producing spinal instability, or epidural abscess causing severe spinal cord compression with new neurologic deficit. A delayed severe combined kyphotic and coronal cervical deformity after cervical decompression is rare, and appropriate surgical management requires careful selection of approach and intraoperative technique.
We present a medically complex 58-year-old male who developed a severe combined kyphotic and coronal cervical deformity in a delayed fashion after an initial posterior cervical decompression for symptomatic epidural abscess associated with VO. The patient underwent a combined two-stage anterior and posterior approach. The patient tolerated both surgeries without complication and follow-up imaging demonstrated correction of cervical sagittal and coronal alignment. Interestingly, despite appropriate antibiotic therapy, intraoperative culture during deformity correction yielded growth of the initial culprit microorganism.
A two-stage anterior and posterior approach with multi-level anterior cervical decompression and instrumented fusion followed by posterior cervicothoracic instrumented fusion addresses the primary surgical goals of affected spinal segment decompression, restoration of appropriate spinal alignment, and prevention of further deformity or neurologic compromise. This report highlights suitability of techniques accessible to most spinal surgeons for correction of a multiplanar deformity, contributes to the ongoing discussion regarding instrumentation in the setting of an active spinal infection, and emphasizes the importance of close clinical and radiographic follow-up in this patient population.
当早期识别失败或未能及时启动针对性抗菌治疗时，椎体骨髓炎（VO）可导致严重的神经损伤。对于严重病例，如出现病理性骨折或畸形导致脊柱不稳定，或硬膜外脓肿引起严重脊髓压迫并伴有新的神经功能缺损的情况，需要进行手术治疗。颈椎减压术后出现延迟性严重的后凸和颈椎冠状面畸形较为罕见，恰当的手术治疗需要仔细选择手术入路和术中技术。
我们报告一例患有多种基础疾病的58岁男性患者，其在因与VO相关的有症状硬膜外脓肿接受初次颈椎后路减压术后，出现了延迟性严重的后凸和颈椎冠状面联合畸形。该患者接受了前后联合两阶段手术。患者耐受了两次手术且未出现并发症，随访影像学检查显示颈椎矢状面和冠状面排列得到矫正。有趣的是，尽管进行了适当的抗生素治疗，但在畸形矫正术中的培养物仍培养出了最初的致病微生物。
前后联合两阶段手术，先行多节段颈椎前路减压及器械辅助融合，随后行颈胸段后路器械辅助融合，可实现受影响脊柱节段减压、恢复适当脊柱排列以及预防进一步畸形或神经功能损害等主要手术目标。本报告强调了大多数脊柱外科医生可采用的技术对于矫正多平面畸形的适用性，为正在进行的关于活动性脊柱感染情况下器械使用的讨论做出了贡献，并强调了对该患者群体进行密切临床和影像学随访的重要性。
