A rare case of aggressive pyogenic spondylitis with giant abscesses after vertebral augmentation
Lin Liu1
, Lei He1, Ga Long2, Min He1
1Department of Orthopeadic Surgery, The Public Health Clinical Center of Chengdu, Chengdu, China
2Department of Orthopeadic Surgery, Dege County People’s Hospital, Ganzi Prefecture, China
Keywords: Abscess, pyogenic spondylitis, Streptococcus constellatus, vertebral augmentation, vertebroplasty.
Abstract
Although Streptococcus constellatus (SC), an opportunistic pathogen, can cause abscesses and empyema. The SC infection after vertebral augmentation (VA) can interfere with patients' daily living activities and can be life-threatening in severe cases. A 67-year-old male complained of lumbar pain for two months. The patient underwent percutaneous vertebroplasty of the second and third lumbar vertebrae two months ago. On admission, laboratory and imaging evidence suggested infection of the second and third lumbar vertebrae with bilateral psoas major and left lumbodorsal abscesses. After three weeks of empirical anti-infective therapy, abscess removal and the second and third lumbar vertebrae fusion with iliac bone graft were performed under general anesthesia. Intraoperative pathology and next-generation sequencing (NGS) examination of the pus suggested SC infection, and oral linezolid was given for 12 weeks after surgery. The infection was eventually cured and the patient achieved satisfactory function. In conclusion, pyogenic spondylitis due to SC infection after VA is a life-threatening complication. In addition to infectious disease consultation and routine etiological screening, NGS is important to identify infection with unknown pathogens. Surgery combined with sensitive antibiotics is appropriate for patients with progressive neurological deficits.
Citation: Liu L, He L, Long G, He M. A rare case of aggressive pyogenic spondylitis with giant abscesses after vertebral augmentation. Jt Dis Relat Surg 2023;34(3):731-736. doi: 10.52312/ jdrs.2023.1182.
* The first and fourth authors contributed equally to this manuscript.
Idea/concept: L.L.; Design: L.H.; Control/supervision: M.H.; Data collection and/or processing: G.L., L.L.; Analysis and/or interpretation: L.L., L.H.; Literature review: L.L., L.H., M.H.; Writing the article: L.L., L.H.; Critical review: M.H.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
A written informed consent was obtained from patient.
The data that support the findings of this study are available from the corresponding author upon reasonable request.