Two Case Reports of Posterior Spinal Fusion With Transpedicular Drainage For Thoracic Pyogenic Spondylitis

• Published in: Journal of Spine Research Vol. 13; no. 7; pp. 992 - 998
• Main Authors: Nakayama, Yuta, Watanabe, Kenichi, Kumanomido, Yuta, Yamaguchi, Yasuteru, Tounosu, Juichi, Abe, Hiroaki, Higashikawa, Akirou
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society for Spine Surgery and Related Research 20.07.2022
• Subjects: Lung abscess; pyogenic spondylitis; transpedicular drainage
• ISSN: 1884-7137; 2435-1563
• DOI: 10.34371/jspineres.2022-0717

Introduction: We report two cases of thoracic pyogenic spondylitis with rapidly worsening myelopathy due to epidural abscess, and two cases of spinal fusion with transpedicular arch drainage for rapid decompression of the spinal cord and rapid control of the infected lesion in patients with pulmonary pyogenic disease and periaortic inflammation.Case Report: Case 1. A 62-year-old man. The patient developed sudden gait disturbance due to muscle weakness in both lower extremities, and bladder and bowel dysfunction. MR imaging of the thoracic spine showed evidence of pyogenic spondylitis and epidural abscess at the Th7-8 level causing significant spinal cord compression. A laminectomy was performed on Th6-8, and transpedicular drainage was inserted into the Th7/8 discs from the root of the Th8, and PPS fixation was performed on Th5, 6-10, and 11. The patient's lower extremity muscle strength gradually improved, and he was able to walk unaided one year after the surgery.Case 2. A 61-year-old woman. A diagnosis of pyogenic spondylitis of Th4/5 was made and antibiotics were started. CT chest on the 5th day of hospitalization showed a pyogenic right lung and inflammation around the aorta, and surgery was performed on the 11th day. The lesion was fixed with PPS at Th 2, 3-6, and 7 on one side without deployment deeper than the muscle layer.On the non-deployed side, transpedicular drainage was percutaneously placed from the Th5 root to the Th4/5 discs. The inflammatory response gradually improved after the surgery, and the patients' symptoms disappeared without further exacerbation.Conclusion: The procedure performed in this case was considered to be effective for immediate decompression of the spinal cord and rapid drainage of the infected area.