PMC9643386_01
A 40-year-old man with Brucella lumbar infection and bilateral isthmus of the L5 vertebral body. (A) Plain x-ray shows degeneration of the lumbar spine, with a slight narrowing of the L4/5 intervertebral space and bilateral isthmus rupture at L5. (B) CT showed "worm-eaten-like" bone destruction in the L4 and L5 vertebral bodies, and L5 lumbar spondylolysis. (C) MRI showed abnormal signal in the L4/5 vertebral body and space, and the formation of abscess in the spinal canal.
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F1
T2 mixed signals in the L4, L5 vertebral bodies and L4/5 intervertebral space, and patchy high and low mixed signals in the spinal canal behind the L5 vertebral body. This result indicated spinal abscess formation (Figure 1). The results of laboratory tests showed elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and decreased hemoglobin and albumin.
Lumbar lesion debridement + VSD drainage through the extreme lateral approach. (A) Locate and mark the body surface (there is a problem with the marking time, and the re-examination is less than 1 year). (B) Schematic of VSD placement. (C) After separation of the psoas major muscle, the C-arm fluoroscopy was performed again to determine the gap, and the channel and distraction device were installed. (D) The VSD sponge was trimmed and placed in the intervertebral space, and another VSD sponge was covered on the body surface.
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F2
The intraoperative blood loss was about 80 ml without blood transfusion (Figure 2).
The third stage of iliac bone grafting and internal fixation. (A-C) During the operation, the iliac bone block was taken from the original incision, placed in the intervertebral space, and then fixed with a self-designed lateral lumbar spine plate. (D) X-ray and (E) MRI were reviewed 1 week after operation, showing that the internal fixation was well in place and the abscess in the spinal canal disappeared.
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F3
One week after the operation, MRI of the lumbar spine showed that the abscess in the spinal canal had disappeared and the implants were in proper position (Figure 3).