PMC10032216_01
Preoperative CT images at admission. (A and B) Sagittal CT images at admission; (C and D) Axial CT image at admission, C6-7 vertebral body destruction.
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Cervical spine CT (Figure 1A-D) at a local hospital showed abnormalities in his C6-7 cervical segment, and conservative treatment was performed with poor results.
Preoperative MRI. (A) Sagittal T2-weighted MRI image; (B) sagittal fat-suppressed MRI image; (C) axial MRI image of the C6-7 disc space. Red arrows indicate hyperintense signals in vertebral bodies and paravertebral tissue.
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C. Cervical magnetic resonance examination found: C6/7 abnormal signals of the vertebral body and intervertebral disc, abscess formation under the anterior longitudinal ligament and spinal canal, compression of the spinal cord, and infectious lesions (Figure 2A-C).
(A and B) Scalded right ankle.
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Additional physical examination findings included: bilateral Achilles tendon reflex (-), knee tendon reflex (-), Hoffmann's sign (-), sphincter contraction without touch, bilateral ankle burn, heavy right side, and second-degree scald (Figure 3A and B).
Preoperative X-ray. Lateral (A) and anteroposterior (B) radiographs before surgery show degeneration of the cervical spine and C6-7 vertebral bone destruction. Postoperative X-ray. Lateral (C) and anteroposterior (D) radiographs show C3-T1 instrumentation (posterior).
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Preoperative X-ray examination showed C6-7 cervical vertebral body abnormalities and cervical spine degeneration (Figure 4A and B), and the operation went smoothly and the decompression was adequate. Postoperative examination of the internal fixation position was good, as seen in perspective (Figure 4C and D), but there was no significant improvement in limb mobility immediately after the operation.
Postoperative MRI. (A) Sagittal fat-suppressed MRI image; (B) sagittal T2-weighted MRI image; (C) Axial MRI image of the C6 vertebra; (D) Axial MRI image of the C7 disc space. Red arrows indicate hyperintense signals in vertebral bodies and paravertebral tissue.
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The MRI reexamination results showed that the cervical spine infection was relieved compared with the previous observation (Figure 5A-D).
Postoperative CT. (A and B) Sagittal CT image; (C and D) Coronal CT image; (E) C6 upper edge of the vertebral body axial CT image; (F) Lower edge of the C6 vertebral body axial CT image.
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CT reexamination of the cervical spine showed that the C6/7 vertebral body was severely damaged and the bone defect was obvious (Figure 6A-F).
Images during the second operation. (A) The white arrow indicates cavities were formed, and blood fluid flowed out; (B) The white arrow indicates that the remaining bone mass at the upper edge of the C6 vertebral body cannot be inserted into the screw; (C) The white arrow indicates that the C6/7 intervertebral space was obviously damaged; (D) A fibular allogeneic bone of appropriate length was placed between the C5-7 vertebral bodies; (E) Schematic diagram of the fibular allogeneic bone; (F) The anterior cervical titanium plate was fixed in front of C5 and C7.
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During the operation, it was found that the lower edge of the C6 vertebral body, the upper edge of the C7 vertebral body, and the C6/7 intervertebral space were obviously damaged, cavities were formed, and some blood gushed out of the cavity (Figure 7A-C). A fibular allogeneic bone of appropriate length (Figure 7D and E) was selected and placed between the C5-7 vertebral bodies, and an anterior cervical titanium plate was fixed in front of C5 and C7 (Figure 7F).
(A and B) H&E staining of C6-7 disc space tissues shows acute and chronic inflammatory cell infiltration and granulation tissue formation.
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The results of pathological culture during the operation showed acute and chronic inflammatory cell infiltration and granulation tissue formation, and the clinical results were consistent with inflammatory lesions (Figure 8A and B).
Postoperative examination images after the second surgery. (A and B) Sagittal CT image (posterior); (C and D) sagittal CT image C5-7 instrumentation (Anterior); (E) C5 lower edge of vertebral body axial CT image; (F) Upper edge of C7 vertebral body axial CT image. Lateral (G) and anteroposterior (H) X-ray.
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The patient's CT (Figure 9A-D) and X-ray (Figure 9G and H) review images showed that the internal fixation position was good, the intervertebral space and C6-7 vertebral bone mass were filled on the CT review image (Figure 9E and F), and the patient was discharged.