PMC10436603_01
(A) X-ray imaging demonstrated destruction of the L4 and L5 vertebral bodies, as well as a decrease in the intervertebral space height. (B) The CT scan revealed a significant amount of bone erosion in the L4 and L5 vertebrae, resembling the effects of a worm-eaten surface. (C) Magnetic Resonance Imaging demonstrated the formation of an abscess in the L4/5 intervertebral space, in the spinal canal, and around the vertebral body. (D, E) Abscesses accumulated in the psoas bilaterally and spread caudally along the intermuscular space. (F, G) An X-ray taken a week after the operation revealed that the internal fixation was in the correct position. (H-J) The postoperative MRI indicated that the abscess had been completely drained and cleared after the Negative Pressure Wound Therapy treatment.
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MRI revealed the presence of an abscess in the lumbar spine, located around the vertebral body, inside the spinal canal, and in the bilateral psoas muscles ( Figures 1A-E ). The X-ray film and MRI of the lumbar spine revealed that the abscess had vanished and the fixation was satisfactory ( Figures 1F-J ).
(A) The following schematic diagram demonstrates the placement of VSD sponge strips. (B) Right lateral position, an extreme lateral surgical incision on the upper border of the anterior superior iliac crest can be designed. (C) The VSD sponge strips were removed from the gap and bilateral psoas abscess prior to the bone graft fusion and internal fixation. (D) The photos taken after the installation of the VSD negative pressure device showed the successful implementation. (E) C-arm fluoroscopy verified the L4/5 intervertebral space. (F) To increase the surgical field, dilation channels were placed in a series of steps. (G, H) Changes of neutrophils before and after NPWT treatment.
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The preoperatively designed VSD sponge should be placed into the bilateral psoas major and L4/5 intervertebral space, as illustrated in  Figure 2 , to guarantee efficient drainage of the intervertebral space and bilateral psoas muscle abscesses ( Figures 2A-F ). Histological analysis of tissue samples taken before and after each surgery demonstrate a significant increase (70% to 89%) in the presence of neutrophils ( Figures 2G, H ).
(A, B) An X-ray taken a week after the operation revealed that the internal fixation was in the correct position. (C-F) The postoperative MRI indicated that the abscess had been completely drained and cleared after the Negative Pressure Wound Therapy treatment.
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In addition, abnormal signals in the lumbar spine, spinal canal, and psoas major muscle had disappeared ( Figure 3 ).