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Percutaneous pedicle screw fixation was effective for bone regeneration after a huge vertebral defect due to
Masaki Tatsumura1, Fumihiko Eto2, Mikiro Kato3
1Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center/Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito, Ibaraki, 310-0015, Japan. tatsumura@md.tsukuba.ac.jp.
Background:
Pyogenic spondylitis by methicillin-resistant Staphylococcus aureus (MRSA) is known to be intractable. In the past, the insertion of an implant into infected vertebra was considered contraindicated in affected patients because it may exacerbate the infection, but there are increasing numbers of reports indicating the usefulness of posterior fixation to correct instability and alleviate infection. Bone grafting is often required to repair large bone defect due to infection, but free grafts can exacerbate infection and are controversial.
Case Presentation:
We present the case of a 58-year-old Asian man with intractable pyogenic spondylitis who had repeated septic shocks due to MRSA. Back pain from repeated pyogenic spondylitis caused by a huge bone defect in L1-2 rendered him unable to sit. Posterior fixation by percutaneous pedicle screws (PPSs) without bone transplantation improved spinal stability and regenerated bone in the huge vertebral defect. He regained his activities of daily living, had no reoccurrence of pyogenic spondylitis nor bacteremia, and was completely cured of the infection without antibiotics after removal of all screws.
Conclusions:
For intractable MRSA pyogenic spondylitis with instability accompanied by a huge bone defect, posterior fixation using PPSs and administration of antibacterial agents stopped the infection, allowed the bone to regenerate, and recovered the patient's activities of daily living.
Insights
Posterior fixation using percutaneous pedicle screws (PPSs) effectively treated intractable methicillin-resistant Staphylococcus aureus (MRSA) pyogenic spondylitis. This approach stabilized the spine, regenerated bone, and allowed a patient to regain daily activities without antibiotics.
Area of Science:
- Orthopedic surgery
- Infectious disease management
- Spinal reconstruction
Background:
- Pyogenic spondylitis caused by methicillin-resistant Staphylococcus aureus (MRSA) presents significant treatment challenges.
- Historically, spinal implants were contraindicated in infected vertebrae due to infection exacerbation risks.
- Posterior fixation is increasingly recognized for its utility in managing spinal instability and infection.
Observation:
- A 58-year-old male patient experienced recurrent septic shocks from intractable MRSA pyogenic spondylitis with a large L1-2 vertebral defect.
- The patient's severe back pain and bone defect prevented him from sitting.
- Percutaneous pedicle screws (PPSs) were employed for posterior fixation without bone grafting.
Findings:
- Posterior fixation with PPSs successfully improved spinal stability and facilitated bone regeneration within the vertebral defect.
- The patient achieved complete infection resolution, with no recurrence of spondylitis or bacteremia, even after hardware removal and without antibiotic use.
- The patient's functional status improved, enabling a return to his usual activities of daily living.
Implications:
- Percutaneous pedicle screw fixation offers a viable strategy for intractable MRSA pyogenic spondylitis with significant bone defects and instability.
- This technique can lead to successful infection control, bone regeneration, and functional recovery.
- The findings challenge previous contraindications for implant use in infected vertebrae, suggesting potential for improved patient outcomes.
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