PMC4582483_01
Left: Posterior bisegmental stabilization and anterior reconstruction after burst fracture of L1. Right: Septic implant loosening: Cage displacement and cut out of the distal pedicle screws after one year.
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F1
The definitive internal spine fixation was performed after 4 weeks (Figure 1 (Fig. 1), Figure 2 (Fig. 2), Figure 3 (Fig. 3)).
Temporary external posterior long segment stabilization (Hoffmann II external fixator, 5 mm pins). Surgical debridement of the anterior column and antibiotic chain spacer implantation.
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F2
The definitive internal spine fixation was performed after 4 weeks (Figure 1 (Fig. 1), Figure 2 (Fig. 2), Figure 3 (Fig. 3)).
Left: Procedural change. Internal posterior stabilization Th11/12 - L2/3 (Longitude/Medtronic; 6.5 mm pedicle screws). The antibiotic chains were left in situ. Because of the good bone quality, a pedicle screw augmentation was not necessary. Right: Removal of the antibiotic chains after further 4 weeks. Due to a progressive osseous bridging, there was no need for an anterior stabilization.
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F3
The definitive internal spine fixation was performed after 4 weeks (Figure 1 (Fig. 1), Figure 2 (Fig. 2), Figure 3 (Fig. 3)).
PMC4582483_02
Left: Adjacent segment instability after L2/3 PLIF. Right: The sagittal and transverse MR Imaging reveals the extended infection spread in the trunk- and psoas muscles. Additionally, there is increasing signal intensity in the adjacent disc space L1/2, that indicates infection.
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F4
After repetitive surgical debridement und soft tissue conditioning the definitive internal instrumentation was possible after 4 weeks (Figure 4 (Fig. 4), Figure 5 (Fig. 5), Figure 6 (Fig. 6), Figure 7 (Fig. 7)).
Temporary external posterior stabilization Th10/11 - L4/5 (Hoffmann II external fixator, 5 mm pins). The intersomatic antibiotic chain interposition after retroperitoneal surgical debridement provides high local antibiotic concentrations.
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F5
After repetitive surgical debridement und soft tissue conditioning the definitive internal instrumentation was possible after 4 weeks (Figure 4 (Fig. 4), Figure 5 (Fig. 5), Figure 6 (Fig. 6), Figure 7 (Fig. 7)).
External spine stabilization using Hoffman II external fixator. The vacuum assisted closure therapy is necessary for soft tissue conditioning.
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F6
After repetitive surgical debridement und soft tissue conditioning the definitive internal instrumentation was possible after 4 weeks (Figure 4 (Fig. 4), Figure 5 (Fig. 5), Figure 6 (Fig. 6), Figure 7 (Fig. 7)).
Posterior long segment internal stabilization Th10/11/12 - L4/5 using cement-augmented pedicle screws (Longitude, Medtronic). Anterior internal fixation as well as palacos spacer implantation between L1 and 2 (Antares, Medtronic).
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F7
After repetitive surgical debridement und soft tissue conditioning the definitive internal instrumentation was possible after 4 weeks (Figure 4 (Fig. 4), Figure 5 (Fig. 5), Figure 6 (Fig. 6), Figure 7 (Fig. 7)).
PMC4582483_03
L1 compression fracture in severe osteoporosis led to kyphosis and spinal cord compression. Long segment posterior stabilization and multilevel decompression.
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F8
The definitive internal stabilization and wound closure occurred after 4 weeks (Figure 8 (Fig. 8), Figure 9 (Fig. 9), Figure 10 (Fig. 10), Figure 11 (Fig. 11), Figure 12 (Fig. 12), Figure 13 (Fig. 13), Figure 14 (Fig. 14)).
The sagittal CT image reveals the extent of the posterior instability.
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F9
The definitive internal stabilization and wound closure occurred after 4 weeks (Figure 8 (Fig. 8), Figure 9 (Fig. 9), Figure 10 (Fig. 10), Figure 11 (Fig. 11), Figure 12 (Fig. 12), Figure 13 (Fig. 13), Figure 14 (Fig. 14)).
Left: Local findings. Right: Intraoperative findings.
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F10
The definitive internal stabilization and wound closure occurred after 4 weeks (Figure 8 (Fig. 8), Figure 9 (Fig. 9), Figure 10 (Fig. 10), Figure 11 (Fig. 11), Figure 12 (Fig. 12), Figure 13 (Fig. 13), Figure 14 (Fig. 14)).
Figure 11. Left: Complete implant removal, radically surgical debridement and external spine fixation with vacuum wound closure (Hoffmann II external fixator, 5.0 mm Pins). Right: X-ray Image of the thoracolumbar spine. External posterior stabilization.
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F11
The definitive internal stabilization and wound closure occurred after 4 weeks (Figure 8 (Fig. 8), Figure 9 (Fig. 9), Figure 10 (Fig. 10), Figure 11 (Fig. 11), Figure 12 (Fig. 12), Figure 13 (Fig. 13), Figure 14 (Fig. 14)).
Follow-up after VAC therapy
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F12
The definitive internal stabilization and wound closure occurred after 4 weeks (Figure 8 (Fig. 8), Figure 9 (Fig. 9), Figure 10 (Fig. 10), Figure 11 (Fig. 11), Figure 12 (Fig. 12), Figure 13 (Fig. 13), Figure 14 (Fig. 14)).
Wound closure
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F13
The definitive internal stabilization and wound closure occurred after 4 weeks (Figure 8 (Fig. 8), Figure 9 (Fig. 9), Figure 10 (Fig. 10), Figure 11 (Fig. 11), Figure 12 (Fig. 12), Figure 13 (Fig. 13), Figure 14 (Fig. 14)).
X-ray image of the final internal posterior stabilization (Longitude, Medtronic; cement-augmented pedicle screws, 7.5 mm)
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F14
The definitive internal stabilization and wound closure occurred after 4 weeks (Figure 8 (Fig. 8), Figure 9 (Fig. 9), Figure 10 (Fig. 10), Figure 11 (Fig. 11), Figure 12 (Fig. 12), Figure 13 (Fig. 13), Figure 14 (Fig. 14)).