J Korean Soc Spine Surg.  2001 Dec;8(4):513-519.

Pyogenic L4-5 Spondylitis Managed with Percutaneous Drainage Followed by Posterior Lumbar Interbody Fusion: A Case Report

• Kim YM
• Won CH
• Seo JB
• Choi ES
• Lee HS
• Um SM

Abstract

STUDY DESIGN: A case report and review of literature
OBJECTIVE
Mostly operative treatment for pyogenic spondylits has been performed via anterior approach, which is often followed by greater morbidity and late sequelae. Efficacy of percutaneous drainage and posterior lumbar interbody fusion (PLIF), which are increasingly applied with favorable results, as an alternative of anterior surgery was investigated. MATERIAL AND METHOD: A case of pyogenic L4-5 spondylitis with psoas abscess but without neurologic deficit in a 66-year old lady was reviewed. Percutaneous drainage under fluoroscopic guide was performed. 7 weeks later, curettage of disc space and posterior lumbar interbody fusion using autogeous graft was performed to get rid of dead space and achieve stability. Administration of antimicrobial agents followed.
RESULTS
Infection was controlled successfully. Clinical features including ambulatory function improved. Solid fusion was achieved. SUMMARY: In treating pyogenic spondylitis with moderate abscess, percutaneous drainage and posterior lumbar interbody fusion seemed to be one of alternatives of anterior surgery.

Keyword

Lumbar; Pyogenic spondylitis. Percutaneous drainage; Posterior lumbar interbody fusion (PLIF)

MeSH Terms

Abscess
Aged
Anti-Infective Agents
Curettage
Drainage*
Humans
Neurologic Manifestations
Psoas Abscess
Spondylitis*
Transplants
Anti-Infective Agents

Figure

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  Fig. 1 A. Initial lateral radiographs shows mild narrowing of L4-5 disc space and subchondral sclerosis adjacent to the end plates. Fig. 1-B. Initial T2-weighted coronal image reveals high signal intensity in L4-5 disc space and moderate bilateral psoas abscess without significant bone destruction.

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  Fig. 2-A. Lateral X-ray at 7 weeks post-PCD shows progression of bony destruction. Fig. 2-B. Preoperative T2-weighted sagittal image reveals expanded intervertebral dead space filled with fluid, L4-5. Fig. 2-C. T2 coronal image shows widened dead space and irregular bony destruction.

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  Fig. 3-A. After thorough curettage of intervertebral dead space and copious irrigation, transpedicular screws were inserted. Fig. 3-B. Continuous suction drainage for 3 weeks followed.

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  Fig. 4-A. Complete solid fusion at postoperative 1 year. Fig. 3-B. Lateral X-ray shows good sagittal alignment.

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