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Ohyama S, Inoue M, Toshi N, Okuyama K, Tokeshi S, Suzuki N, Shiga Y, Inage K, Yawara E, Orita S, Ohtori S. Retroperitoneal Continuous Local Antibiotic Perfusion for Refractory Pyogenic Vertebral Osteomyelitis: A Case Report. Cureus 2023; 15:e50636. [PMID: 38226091 PMCID: PMC10789547 DOI: 10.7759/cureus.50636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/17/2024] Open
Abstract
Pyogenic vertebral osteomyelitis (PVO) is a prevalent infection in the elderly, frequently complicated by iliopsoas and epidural abscesses. Traditional treatments are often ineffective for refractory cases. In this report, a 76-year-old man with PVO, iliopsoas, and epidural abscess was unresponsive to antibiotics, presenting with severe lower back pain and functional impairments. A two-stage surgical intervention was implemented: anterior debridement, autogenous bone graft fixation, and novel application of retroperitoneal continuous local antibiotic perfusion (CLAP), followed by posterior fixation. A contrast test verified correct CLAP perfusion into the iliopsoas abscess and intervertebral disc space. Substantial improvements were noted postoperatively, including a marked reduction in pain, inflammation, and the size of both abscesses. In conclusion, this case demonstrates the feasibility and effectiveness of retroperitoneal CLAP in treating refractory PVO, offering a potential innovative solution for cases resistant to conventional therapies.
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Affiliation(s)
- Shuhei Ohyama
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Masahiro Inoue
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Noriyasu Toshi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Kohei Okuyama
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Soichiro Tokeshi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Noritaka Suzuki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Yasuhiro Shiga
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Kazuhide Inage
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Eguchi Yawara
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
- Department of Orthopedic Surgery, Center for Frontier Medical Engineering, Chiba University, Chiba, JPN
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
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