Combined anterior and posterior instrumented fusion for correction of severe cervical kyphotic and coronal deformity in vertebral osteomyelitis: a case report with literature review
Case Report

Combined anterior and posterior instrumented fusion for correction of severe cervical kyphotic and coronal deformity in vertebral osteomyelitis: a case report with literature review

Amanda Bingaman1, Rohan V. Gupta2, Srinivasa P. Kanuparthi2, Bong-Soo Kim2

1Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA; 2Department of Neurosurgery, Temple University Hospital, Philadelphia, PA, USA

Contributions: (I) Conception and design: All authors; (II) Administrative support: BS Kim; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Bong-Soo Kim, MD. Department of Neurosurgery, Temple University Hospital, 3401 N Broad Street, Suite C540, Philadelphia, PA 19140, USA. Email: Bong-Soo.Kim@tuhs.temple.edu.

Background: Vertebral osteomyelitis (VO) can cause devastating neurological injury when there is a failure in early identification or prompt initiation of targeted antimicrobial therapy. Surgery is indicated for severe cases, such as those with a pathologic fracture or deformity producing spinal instability, or epidural abscess causing severe spinal cord compression with new neurologic deficit. A delayed severe combined kyphotic and coronal cervical deformity after cervical decompression is rare, and appropriate surgical management requires careful selection of approach and intraoperative technique.

Case Description: We present a medically complex 58-year-old male who developed a severe combined kyphotic and coronal cervical deformity in a delayed fashion after an initial posterior cervical decompression for symptomatic epidural abscess associated with VO. The patient underwent a combined two-stage anterior and posterior approach. The patient tolerated both surgeries without complication and follow-up imaging demonstrated correction of cervical sagittal and coronal alignment. Interestingly, despite appropriate antibiotic therapy, intraoperative culture during deformity correction yielded growth of the initial culprit microorganism.

Conclusions: A two-stage anterior and posterior approach with multi-level anterior cervical decompression and instrumented fusion followed by posterior cervicothoracic instrumented fusion addresses the primary surgical goals of affected spinal segment decompression, restoration of appropriate spinal alignment, and prevention of further deformity or neurologic compromise. This report highlights suitability of techniques accessible to most spinal surgeons for correction of a multiplanar deformity, contributes to the ongoing discussion regarding instrumentation in the setting of an active spinal infection, and emphasizes the importance of close clinical and radiographic follow-up in this patient population.

Keywords: Coronal deformity; vertebral osteomyelitis (VO); fusion with instrumentation; case report

Submitted Oct 01, 2024. Accepted for publication Jan 22, 2025. Published online Apr 14, 2025.

doi: 10.21037/jss-24-133

Highlight box

Key findings

• Rare case report of a delayed coronal deformity after posterior decompression of vertebral osteomyelitis (VO) with epidural abscess requiring a combined anterior and posterior approach with instrumentation for correction.

• Even with adequate antibiotic treatment for osteomyelitis, operative cultures were positive for microbial growth.

What is known and what is new?

• Delayed coronal deformity after posterior decompression for symptomatic VO with epidural abscess is rarely reported. However, it can be corrected with a combination of anterior and posterior instrumented approaches familiar to most spinal surgeons.

• Although the patient completed adequate antibiotic treatment, positive intraoperative cultures during his deformity correction suggest ongoing infection and raise questions regarding sterilization status if hardware were implanted up-front alongside decompression in this disease process.

What is the implication, and what should change now?

• Close radiographic follow-up after surgical treatment of VO and epidural abscess is recommended to identify deformity.

• Further studies are needed to examine sterilization status of patients with VO and epidural abscess receiving up-front hardware instrumentation after decompression.

Introduction

Vertebral osteomyelitis (VO) most commonly arises from hematogenous seeding of a remote infectious site and represents 1–7% of all bony infections. Of these infections, the cervical spine is implicated in 3–10% of cases, and S. aureus is the responsible organism in approximately 40–80% of these cases (1-4). Age-related morphological alteration of spinal segmental arteries, the presence of disrupted bony architecture (e.g., osteoarthritis), and sluggish high-volume flow through the vertebral marrow can enable formation of a spontaneous suppurative infection classically involving adjacent vertebral endplates and the intervening disc in the presence of bacteremia. Epidemiological data showing increasing VO incidence likely reflect the higher comorbidity burden of an aging population alongside the broadened availability of advanced neuroimaging (3-6). This trend should encourage critical analysis of the medical and surgical treatment of this disease process at all stages. Accordingly, targeted antimicrobial therapy is the mainstay of treatment for isolated VO. However, in severe cases, such as those with a pathologic fracture, deformity producing spinal instability, or epidural abscess causing severe spinal cord compression with new neurologic deficit, surgery remains the indicated treatment. The primary goals of surgery are decompression of the affected spinal segments, restoration of appropriate spinal alignment, and prevention of further deformity or neurologic compromise through instrumented fusion (2,7).

In the surgical treatment of cervical VO, the primary treatment options are decompression alone or decompression in combination with instrumented fusion concurrent with targeted antimicrobial treatment. There is controversy regarding the safety of instrumented fusion during an acute infection due to possible hardware infection versus performing instrumented fusion after antimicrobial sterilization, which minimizes that risk (8-13). However, in patients that undergo cervical decompression alone, there is also concern that these patients may develop cervical deformity in either an acute or delayed fashion, most commonly presenting as kyphosis in the sagittal plane (14). The development of a severe combined kyphotic and coronal cervical deformity in a delayed fashion after cervical decompression and appropriate antibiotic treatment of cervical osteomyelitis (OM) is a rare finding. Management in this setting requires unique treatment considerations, including the appropriate selection of approach (anterior, posterior, or combination), and intraoperative surgical technique (corpectomy, posterior instrumentation, traction, or combination), for restoration of optimal alignment in both the sagittal and coronal planes. There is no standardized approach, and high-quality evidence regarding the most effective strategy in this patient population remains limited.

We present the unique case of a patient requiring surgery to treat a delayed severe combined kyphotic and coronal cervical deformity due to destructive OM following posterior decompression for symptomatic cervical epidural abscess associated with VO. The patient underwent a planned anterior-posterior approach with multi-level anterior cervical decompression and instrumentation, followed by posterior cervicothoracic instrumented fusion. We present this case in accordance with the CARE reporting checklist (available at https://jss.amegroups.com/article/view/10.21037/jss-24-133/rc).

Case presentation

A 58-year-old male with a past medical history of heart failure with reduced ejection fraction, human immunodeficiency virus on highly active antiretroviral therapy, end-stage renal disease on intermittent hemodialysis, and recurrent methicillin-resistant Staphylococcus aureus bacteremia presented with cervical OM and an epidural abscess causing cervical cord compression and a cervical sensory level with decreased sensation below that level (Figure 1). The infection source was determined to be an infected hemodialysis catheter, which was subsequently removed. The patient underwent posterior cervical decompression, C3–6, for epidural abscess and phlegmon evacuation with some improvement in strength and sensation (Figure 2). He was ultimately transferred to a skilled nursing facility for the remainder of his post-operative care, and planned for instrumented fusion after completion of antibiotics. The patient was ultimately lost to follow-up and presented approximately four months later with worsening neck pain. A computed tomography (CT) cervical spine without contrast performed at that time demonstrated the new development of a severe combined kyphotic and coronal cervical deformity due to cervical OM with significant destruction of the C3, C4, and C5 vertebral bodies (Figure 3). Given these findings, the patient was planned for an anterior and posterior approach over two separate surgeries.

Figure 1 Pre-operative scan demonstrating destructive OM and severe combined sagittal kyphotic and coronal deformity. CT cervical spine without contrast: (A) left; (B) mid-sagittal; (C) right. MRI cervical spine without contrast: (D) mid-sagittal T2WI. CT, computed topography; MRI, magnetic resonance imaging; T2WI, T2-weighted image; OM, osteomyelitis.
Figure 2 Post-operative scan demonstrating post-operative changes after posterior decompression and evacuation of epidural phlegmon. CT cervical spine without contrast: (A) left; (B) mid-sagittal; (C) right. MRI cervical spine without contrast: (D) mid-sagittal T2WI. CT, computed topography; MRI, magnetic resonance imaging; T2WI, T2-weighted image.
Figure 3 Pre-operative scan demonstrating severe sagittal kyphotic deformity after loss to follow-up. CT cervical spine without contrast: (A) mid-sagittal; MRI cervical spine without contrast: (B) mid-sagittal T2WI. CT, computed topography; MRI, magnetic resonance imaging; T2WI, T2-weighted image.

The patient initially underwent an anterior approach with C3, C4, and C5 corpectomies, and C2-C6 fusion with instrumentation. Under general anesthesia and endotracheal intubation, the patient was positioned supine onto a flat Jackson table in the operating room. Gardner Wells tongs were placed and attached to a rope pulley system. Fluoroscopy was used to obtain baseline alignment, and then 10 pounds of weight was placed with continuous neuromonitoring to ensure no changes. Repeat fluoroscopy assessed adequacy of distraction and reduction of the deformity. This maneuver was repeated with incremental addition of weight, continuous neuromonitoring, and repeat fluoroscopy until there was improvement in sagittal and coronal alignment, ultimately requiring placement of 50 pounds total. Intra-operative fluoroscopy was then utilized to identify the appropriate levels, and an incision was planned along the medial border of the right sternocleidomastoid muscle. An appropriate anterior cervical neck dissection was performed to have sufficient opening to access the C2–3 disc space cranially and the C5–6 disc space caudally. Destruction of the C3, C4, and C5 vertebral bodies from OM was evident at this time along with significant inflammatory phlegmon and granulation tissue, which was collected and sent for culture. Under enhanced magnification and illumination of the operating microscope, we performed discectomies at C2–3 and C5–6 followed by corpectomies at C3, C4, and C5 using standard technique. After an adequate decompression was achieved, we prepared the endplates and proceeded with placement of our instrumentation. We then placed an expandable cage, noting good endplate apposition on fluoroscopy. The cage was secured cranially with screws placed through the inferior portion of the C2 vertebral body and caudally with screws placed through the superior portion of the C6 vertebral body. Screw placement was confirmed with both anterior/posterior and lateral fluoroscopy, with good bony purchase along with desired reduction of the deformity. We proceeded with closure in standard fashion. The patient was transferred to the intensive care unit in stable condition and kept intubated in preparation for the posterior approach.

The patient returned to the operating room as planned for the posterior approach characterized by a cervicothoracic fusion, C1–T1, with instrumentation, and underwent induction of general anesthesia. With care taken to maintain a neutral alignment of the cervical spine, the patient was positioned prone onto an open Jackson table. Gardner Wells tongs were placed and connected to a rope pulley system with additional weight placed as needed to maintain optimal alignment. Intraoperative fluoroscopy was again utilized to identify the appropriate levels for planning and marking the incision. Dissection initially began at the craniocervical junction to carefully expose the C1 and C2 lateral masses bilaterally and dissection was carried caudally to expose the subaxial lateral masses and T1 pedicles bilaterally. Additional friable tissue and purulent material were encountered, collected, and sent for culture. After adequate exposure, screws were placed in the C1 and subaxial lateral masses, C2 pars, and T1 pedicles using standard technique. Due to significant lateral mass destruction from OM, the right C4 and bilateral C5 screws were not placed. Screw placement was confirmed on fluoroscopy and appropriate length rods were placed within the screw heads bilaterally, secured with set screws, and final-tightened in place. At this time, the weight was removed, meticulous hemostasis was achieved, and we proceeded with closure in standard fashion.

The patient was ultimately extubated and remained both hemodynamically and neurologically stable in the immediate post-operative period. A CT cervical spine without contrast demonstrated expected post-surgical changes, appropriate instrumentation, and correction of the deformity with more appropriate alignment (Figures 4,5). Intra-operative cultures grew methicillin-resistant Staphylococcus aureus and the patient was placed on an additional 6-week course of intravenous daptomycin and ceftazidime per infectious disease recommendations. The patient tolerated both surgeries and the antibiotic regimen well, and was ultimately discharged to his prior skilled nursing facility in stable condition.

Figure 4 Post-operative scan demonstrating appropriate instrumentation, stabilization, improvement in alignment, and reduction of combined kyphotic and coronal deformity. CT cervical spine without contrast: (A) left sagittal, (B) mid-sagittal, (C) right sagittal, (D) coronal; (E) MRI cervical spine without contrast, mid-sagittal T2WI. CT, computed tomography; MRI, magnetic resonance imaging, T2WI, T2-weighted imaging.
Figure 5 3D CT cervical spine reconstruction showing pre- and post-operative correction of a complex multiplanar deformity. (A) Pre-operative coronal; (B) pre-operative sagittal; (C) post-operative coronal; (D) post-operative sagittal. 3D, 3-dimensional; CT, computed topography.

At 6-month follow-up, the patient remained in stable condition without evidence of further infection or hardware failure.

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent for publication of this case report and accompanying images was not obtained from the patient or the relatives after all possible attempts were made.

Discussion

Treatment of cervical VO with associated epidural abscess, spinal cord compression, and acute neurologic deficit requires surgical intervention in conjunction with appropriate antimicrobial treatment. The decision for decompression alone or decompression with instrumented fusion in the setting of VO with an active infection is an area of controversy. The development of a severe combined kyphotic and coronal cervical deformity after decompression in a delayed fashion is of great concern, and the most appropriate treatment strategy should this occur is not well characterized (1,2,15,16). We present a 58-year-old medically complex male who underwent surgery with a planned anterior-posterior approach to treat a delayed severe combined kyphotic and coronal cervical deformity due to destructive OM following posterior cervical decompression for symptomatic cervical epidural abscess associated with VO.

Surgical treatment is often a complex decision, as a multilevel posterior cervical decompression alone predisposes a patient to an increased risk of developing cervical kyphosis (17-19). Conversely, instrumented fusion during active VO carries a risk of a hardware infection (20,21). Ha et al. showed dense biofilm development by S. epidermidis on all tested spinal implant surfaces, suggesting difficult sterilization without implant removal and intravenous antimicrobial therapy alone (22). Accordingly, multiple groups have historically approached spinal infection via staged initial debridement antecedent to predominantly posterior instrumentation for avoidance of hardware placement in the setting of critical illness and active infection (11-13). More recent large institutional series provide increasing evidence that instrumentation after decompression in a single surgery for patients with active spinal infection can be done safely and with a low rate of implant removal (8-10). Timely diagnosis, targeted antimicrobial therapy, careful patient selection, aggressive debridement of infected tissue, and close clinical and radiographic monitoring remain cornerstones for successful infection clearance and prevention of delayed deformity in these patients.

The development of a coronal deformity of the cervical spine is overall a rare phenomenon. In a study by Kim et al., of the 90 patients with cervical deformity who underwent surgical correction, only 8 patients (8.9%) had a coronal deformity (23). Furthermore, the delayed development of a severe combined kyphotic and coronal cervical deformity of the cervical spine following posterior cervical decompression in VO is even more rare, with the appropriate surgical management unclear should this occur. In our case, the primary objective was to decompress the spinal cord, improve sagittal and coronal alignment, and stabilize the cervical spine to prevent further radiographic or neurologic deterioration. We felt that this would be best accomplished by an anterior approach to decompress the spine and improve alignment, followed by a posterior approach for further stabilization. Traction was utilized intraoperatively to improve alignment under fluoroscopic guidance with continuous neuromonitoring, and an anterior corpectomy with instrumented fusion was utilized to remove the destroyed vertebral bodies for direct decompression and deformity reduction. Posterior instrumented fusion was then performed to stabilize the cervical spine, prevent deformity progression, or the development of additional neurologic deficits.

Although our severe combined kyphotic and coronal deformity is a rare phenomenon, only a few studies have investigated the success of a combined anterior and posterior approach for instrumented fusion in cervical VO (Table 1). In Schimmer et al.’s study, two of the nine patients who underwent a combined approach developed post-operative complications: one patient developed pseudoarthrosis and another patient developed a deep wound infection (1). In Hahn et al.’s study, two patients with a kyphotic deformity underwent a combined approach without any complications (24). Park et al. had 42 patients undergoing a combined approach via either a two- versus single-stage operation, demonstrating no significant difference in terms of infection recurrence (5). Though these studies did not specifically investigate patients with a coronal deformity or provide detailed information regarding intraoperative technique, they suggest a favorable outcome following a combined anterior and posterior approach, which can be separated into a two-stage surgery without significant concerns.

Table 1

Summary of reported cases, offending organisms, and surgical approach

Study Cases (n) Age range (years) Gender Organism Spinal segments Operative approach
Schimmer et al., 2002 (1) 15 45–82 Male: 13, female: 2 S. aureus (n=8), E. coli (n=2), M. tuberculosis (n=1), S. intermedius (n=1), Klebsiella (n=1), not identified (n=2) C1–2 (n=2), C3–5 (n=1), C4–5 (n=1), C5–6 (n=6), C6–7 (n=3), C7–T1 (n=2) All patients underwent anterior debridement (n=15); some patients underwent anterior fusion only (n=2), posterior fusion only (n=3), anterior & posterior fusion (n=9), and debridement alone (n=1)
Hahn et al., 2014 (24) 14 21–72 Male: 10, female: 4 MRSA (n=5), M. tuberculosis (n=4), P. aeruginosa (n=1), P. aeruginosa changed to MRSA (n=1), MRCNS (n=1), no growth (n=2) C1–2 (n=1), C3–4 (n=1), C3–5 (n=1), C4–5 (n=1), C4–6 (n=1), C4–7 (n=1), C4–T1 (n=1), C5–6 (n=3), C5–7 (n=1), C5–T1 (n=1), C6–7 (n=1), C7/T1 (n=1) Single stage: debridement only (n=5), anterior fusion (n=5), anterior & transthoracic fusion (n=1); two-stage: anterior & posterior fusion (n=2), debridement & posterior fusion (n=1)
Park et al., 2015 (5) 153 59–72 Male: 78, female: 75 S. aureus (n=81), aerobic gram-negative bacteria (n=37), Streptococcus species (n=17), coagulase-negative Staphylococci (n=8), Enterococci (n=4), anaerobes (n=3), other/unspecified (n=1), and polymicrobial (n=2) Cervical spine (n=16), involvement of thoracic spine (n=40), involvement of lumbosacral spine (n=113) Debridement alone (n=94), debridement prior to instrumented fusion (n=59); of those undergoing instrumented fusion, some patients received single-stage surgery (n=24), the rest undergoing two-stage surgery (n=35)

MRCNS, methicillin-resistant coagulase-negative Staphylococci; MRSA, methicillin-resistant Staphylococcus aureus.

Conclusions

We present a rare case of a delayed severe multiplanar deformity after posterior decompression for symptomatic cervical epidural abscess and VO. The patient underwent successful deformity correction via a planned two-stage anterior and posterior approach using techniques accessible to most spinal surgeons. Despite adequate antibiotic treatment, intraoperative cultures during deformity correction yielded growth of the initial culprit microorganism. This report thereby adds additional perspective to the ongoing discussion regarding the timing of instrumentation in the setting of active spinal infection, characterizes a rarely reported long-term sequelae in this patient population, and highlights the need for regular clinical and radiographic follow-up.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the CARE reporting checklist. Available at https://jss.amegroups.com/article/view/10.21037/jss-24-133/rc

Peer Review File: Available at https://jss.amegroups.com/article/view/10.21037/jss-24-133/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jss.amegroups.com/article/view/10.21037/jss-24-133/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent for publication of this case report and accompanying images was not obtained from the patient or the relatives after all possible attempts were made.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

  1. Schimmer RC, Jeanneret C, Nunley PD, et al. Osteomyelitis of the cervical spine: a potentially dramatic disease. J Spinal Disord Tech 2002;15:110-7. [Crossref] [PubMed]
  2. Acosta FL Jr, Chin CT, Quiñones-Hinojosa A, et al. Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine. Neurosurg Focus 2004;17:E2. [Crossref] [PubMed]
  3. Hadjipavlou AG, Mader JT, Necessary JT, et al. Hematogenous pyogenic spinal infections and their surgical management. Spine (Phila Pa 1976) 2000;25:1668-79. [Crossref] [PubMed]
  4. Jensen AG, Espersen F, Skinhøj P, et al. Increasing frequency of vertebral osteomyelitis following Staphylococcus aureus bacteraemia in Denmark 1980-1990. J Infect 1997;34:113-8. [Crossref] [PubMed]
  5. Park KH, Cho OH, Lee YM, et al. Therapeutic outcomes of hematogenous vertebral osteomyelitis with instrumented surgery. Clin Infect Dis 2015;60:1330-8. [Crossref] [PubMed]
  6. Nickerson EK, Sinha R. Vertebral osteomyelitis in adults: an update. Br Med Bull 2016;117:121-38. [Crossref] [PubMed]
  7. Scheer JK, Ames CP, Deviren V. Assessment and treatment of cervical deformity. Neurosurg Clin N Am 2013;24:249-74. [Crossref] [PubMed]
  8. Shad A, Shariff S, Fairbank J, et al. Internal fixation for osteomyelitis of cervical spine: the issue of persistence of culture positive infection around the implants. Acta Neurochir (Wien) 2003;145:957-60; discussion 960. [Crossref] [PubMed]
  9. Bydon M, De la Garza-Ramos R, Macki M, et al. Spinal instrumentation in patients with primary spinal infections does not lead to greater recurrent infection rates: an analysis of 118 cases. World Neurosurg 2014;82:e807-14. [Crossref] [PubMed]
  10. Rayes M, Colen CB, Bahgat DA, et al. Safety of instrumentation in patients with spinal infection. J Neurosurg Spine 2010;12:647-59. [Crossref] [PubMed]
  11. DE LA Garza-Ramos R. Instrumented fusion in the setting of primary spinal infection. J Neurosurg Sci 2017;61:64-76. [PubMed]
  12. Dimar JR, Carreon LY, Glassman SD, et al. Treatment of pyogenic vertebral osteomyelitis with anterior debridement and fusion followed by delayed posterior spinal fusion. Spine (Phila Pa 1976) 2004;29:326-32; discussion 332. [Crossref] [PubMed]
  13. Faraj AA, Webb JK. Spinal instrumentation for primary pyogenic infection report of 31 patients. Acta Orthop Belg 2000;66:242-7. [PubMed]
  14. Steinmetz MP, Stewart TJ, Kager CD, et al. Cervical deformity correction. Neurosurgery 2007;60:S90-7. [Crossref] [PubMed]
  15. Malawski SK, Lukawski S. Pyogenic infection of the spine. Clin Orthop Relat Res 1991;58-66. [PubMed]
  16. Jeanneret B, Magerl F. Treatment of osteomyelitis of the spine using percutaneous suction/irrigation and percutaneous external spinal fixation. J Spinal Disord 1994;7:185-205. [Crossref] [PubMed]
  17. Albert TJ, Vacarro A. Postlaminectomy kyphosis. Spine (Phila Pa 1976) 1998;23:2738-45. [Crossref] [PubMed]
  18. Kaptain GJ, Simmons NE, Replogle RE, et al. Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy. J Neurosurg 2000;93:199-204. [PubMed]
  19. Mummaneni PV, Deutsch H, Mummaneni VP. Cervicothoracic kyphosis. Neurosurg Clin N Am 2006;17:277-87. vi. [Crossref] [PubMed]
  20. Tretiakov PS, Joujon-Roche R, Williamson T, et al. Assessing the Effects of Prior History of Vertebral Osteomyelitis on Peri-Operative Factors and Post-Operative Recovery in Adult Spinal Deformity Patients. J Clin Med 2022;11:6488. [Crossref] [PubMed]
  21. Fayazi AH, Ludwig SC, Dabbah M, et al. Preliminary results of staged anterior debridement and reconstruction using titanium mesh cages in the treatment of thoracolumbar vertebral osteomyelitis. Spine J 2004;4:388-95. [Crossref] [PubMed]
  22. Ha KY, Chung YG, Ryoo SJ. Adherence and biofilm formation of Staphylococcus epidermidis and Mycobacterium tuberculosis on various spinal implants. Spine (Phila Pa 1976) 2005;30:38-43. [Crossref] [PubMed]
  23. Kim HJ, Virk S, Elysee J, et al. Surgical Strategy for the Management of Cervical Deformity Is Based on Type of Cervical Deformity. J Clin Med 2021;10:4826. [Crossref] [PubMed]
  24. Hahn BS, Kim KH, Kuh SU, et al. Surgical Treatment in Patients with Cervical Osteomyelitis: Single Institute's Experiences. Korean J Spine 2014;11:162-8. [Crossref] [PubMed]
Cite this article as: Bingaman A, Gupta RV, Kanuparthi SP, Kim BS. Combined anterior and posterior instrumented fusion for correction of severe cervical kyphotic and coronal deformity in vertebral osteomyelitis: a case report with literature review. J Spine Surg 2025;11(2):363-370. doi: 10.21037/jss-24-133

Article Options

Download Citation

Share