PMC3485901_01
(a) Sagittal MRI, T1 showing the extension of the infectious process to three vertebral bodies L3-L4-L5 and to the intervertebral discs, as in a case of spondylodiscitis. ((b) and (d)) Axial MRI, T2 showing the paravertebral extension of the infection as well as an important compression of the sack and roots by the infection. ((c) and (d)) Sagittal CT showing the erosion and an extended rehashing of the bone as well as the involvement of the aortic prosthesis which has in part been pushed forwards by the infection. The CT also shows the integrity of the vertebral plain of the vertebrae adjacent to the damaged ones.
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fig1
(a) Intraoperative picture showing the placement of the expansion mesh. ((b) and (c)) Follow-up pictures taken 12 months apart. They show the correct placement of the fixation system. The mesh is in place with a 3 mm settling. To be noted here is the natural inclination of the mesh on the inferior end plate. This has allowed for restitution of a partial lordosis to the lumbar-sacral column.
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fig2
An expansion mesh was then placed (Figure 2); it was gradually expanded so as to reduce as much as possible the kyphosis (measurements as to the size of the mesh were based on the preoperative CT). The last checkups, radiological and haematological, 24 months later, have shown no alterations (Figure 2).
PMC3485901_02
(a) Sagittal MRI T2: here the infectious process has involved two vertebral bodies with an initial tightening of the canal even if it is still possible to identify signs of the liquor around the spinal cord. The paravertebral extension is clearly visible. (b) Sagittal CT: it highlights the marked kyphotic deformation caused by the complete erosion of the bone by the infection, in particular to the inferior vertebral body. (c) Postoperative sagittal CT: highlighted here is the correct positioning of the mesh as well as the restitution of the correct curvature to the dorsal rachises.
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fig3
T11-T12 (Figure 3). This was eroding them and causing the beginning of a kyphosis of the rachis.
(a) Picture of the position of a patient in the operating room for the lateral thoracotomy approach, with the ipsilateral arm raised. (b) Intraoperative picture showing bone erosion by the infection. (c) During the surgical procedure the site is repeatedly washed with 0.9% physiological solution so as to clear as much as possible the surgical field. (d) Final intraoperative picture. It shows the placement of the mesh and the plaque.
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fig4
There then was a debridement with resection of all infected and necrotic tissue so as to visualise the inferior end plate of T10 and the superior end plate of L1 (Figure 4). 