Revision Reconstruction of the Cervical Spine in a Patient With Early Deep Surgical Site Infection Complicated by Angular Kyphosis: Case Report and Review

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Abstract

Background. Deep surgical site infection (DSSI) is one of the most severe complications in spinal surgery. The timing and nature of DSSI are the determining criteria in the choice of treatment tactics. The uniqueness of the clinical observation is the combination of early DSSI, epidural abscess and angular kyphotic deformity formed after a course of conservative antibacterial therapy in a patient who underwent surgery for degenerative-dystrophic disease of the cervical spine. Correction of angular kyphosis, removal of fractured vertebrae, interbody implants and three-column cervical reconstruction were performed in one surgical session.

Case presentation. A 57-year-old patient was admitted to the clinic after staged surgical interventions on the cervical spine for multilevel degenerative stenosis of the spinal canal. The primary surgical interventions were complicated by DSSI in the early period after the second surgery with formation of angular kyphosis of the cervical spine. The patient underwent revision one-stage reconstructive intervention to correct the deformity, decompress the spinal canal, and three-column reconstruction of C3-7 segments. Long-term follow-up showed persistent reduction of pain syndrome, improved quality of life and absence of recurrence of DSSI.

Conclusion. The presented case illustrates the possibilities of one-stage revision three-column cervical spine reconstruction for correction of sagittal profile, decompression of intracanal neural structures and ensuring stability of operated segments. Use of DSSI treatment algorithms based on Prinz V. and Vajkoczy P. classification contributes to the selection of the optimal tactics of patient management.

About the authors

Denis G. Naumov

St. Petersburg State Research Institute of Phthisiopulmonology; St. Petersburg State University

Author for correspondence.
Email: dgnaumov1@gmail.com
ORCID iD: 0000-0002-9892-6260

Cand. Sci. (Med.)

Russian Federation, St. Petersburg; St. Petersburg

Sergey G. Tkach

St. Petersburg State Research Institute of Phthisiopulmonology

Email: tkach2324sergei@yandex.ru
ORCID iD: 0000-0001-7135-7312
Russian Federation, St. Petersburg

Anton A. Ladygin

Federal Network of Medical Centers “MRI Expert”

Email: ladygin-antony1982@inbox.ru
ORCID iD: 0000-0002-2003-9987
Russian Federation, Apatity

Mikhail M. Shchelkunov

St. Petersburg State Research Institute of Phthisiopulmonology

Email: mm.shelkunov1881@yandex.ru
ORCID iD: 0000-0002-6305-6023
Russian Federation, St. Petersburg

Andrey A. Karpushin

St. Petersburg State Research Institute of Phthisiopulmonology

Email: karpushin@lyag.ru
ORCID iD: 0000-0002-7178-3861
Russian Federation, St. Petersburg

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2. Fig. 1. MRI (a — T2 images; b — STIR images): C3–С7 polysegmental degenerative changes, spinal canal stenosis, C6–С7 end plates oedema type I Modic, polysegmental myelopathy C4–С7

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3. Fig. 2. MRI (a — T2 images; b — STIR images) and CT (c) after the first operation: two interbody implants (PEEK cages) are identified at the C5–С6, C6–С7, C4–С6 ossification of the posterior longitudinal ligament (segmental type according to the Committee on the Ossification of the Spinal Ligaments)

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4. Fig. 3. MRI after the second operation: a — STIR images; b — T2 images: prevertebral, epidural abscesses, C3–С5 spondylitis, focal myelopathy at C2–С3

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5. Fig. 4. X–ray (a), CT (b) and MRI (c) at the time of hospital admission: angular kyphosis 48° Cobb, destruction of C3–С5, myelopathy at C2–С3, no signs of active inflammatory process (abscesses)

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6. Fig. 5 (a, b, c, d). Sagittal (a) and frontal (b) X–rays, sagittal CT (c) 10 months after surgery: posterior transpedicular screw fixation correct position, solid anterior fusion C3–C7 formation detected. (d) - Axial (d) CT: posterior transpedicular screw fication correct position, solid anterior fusion C3–C7 formation detected

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