Upper Thoracic Pyogenic Spondylitis With a Paravertebral Abscess Treated With a Combination of Cranked Minimally Invasive Spinal Instrumentation and Negative Pressure Wound Therapy: A Case Report

Abstract

Pyogenic spondylitis is generally managed conservatively; however, surgical intervention may be required depending on the patient's condition. In this report, we present a case of upper thoracic pyogenic spondylitis with a paravertebral abscess that was successfully treated using negative pressure wound therapy (NPWT) combined with a cranked rod construct and a minimally invasive posterior-only approach. This report was constructed based on previous medical records and imaging findings. A 51-year-old man with a paravertebral abscess developed pyogenic spondylitis of the upper thoracic spine (T2 and T3). Surgical treatment was chosen due to severe neurological deficits and the presence of a paravertebral abscess. However, a posterior approach for drainage and debridement was implemented to avoid damage to proximal organs. Posterior instrumented fixation surgery from the cervical spine (C6) to the thoracic spine (T6) was performed to reduce pain and maintain alignment owing to the instability of the affected vertebrae. After pedicle screw insertion, open debridement and drainage of the T2/T3 disc space and paravertebral abscess were performed using a costotransversectomy window. Because debridement was only partially possible intraoperatively with the posterior approach, NPWT was used in combination with this approach to ensure continuous postoperative drainage. To avoid exposure of the metal instrumentation to the contaminated area, the right-side rod was passed around the drainage side with connectors. Two weeks after NPWT, the wound was closed under general anesthesia. Herein, we describe the successful treatment of primary pyogenic spondylitis with a paravertebral abscess in the upper thoracic spine using posterior instrumentation surgery combined with NPWT. In cases where complete debridement of infected tissue is not achieved, NPWT may serve as a valuable adjunctive treatment.