title: Pyogenic spondylitis in the cervicothoracic junction with high-positioned aortic arch. Case report and review of the literature.
abstract: The authors report the case of an 87-year-old woman who suffered from T1-2 pyogenic spondylitis resulting in progressive and severe paraplegia. Debridement and anterior manubrium-splitting fusion were difficult because a high-positioned aortic arch was very close to the infectious lesion. Because adequate intravenous antibiotic agents had nearly resolved the inflammation, the authors undertook anterior debridement and posterior fusion that involved costotransversectomy and the placement of a posterior cervical pedicle screw fixation system. At 1.5 years postoperatively, there were no signs of recurrent infection. Solid osseous union was documented, and the patient's paraplegia had improved. A high-positioned aortic arch will likely interfere with an anterior approach to the cervicothoracic junction. If adequate antibiotic therapy has successfully controlled the spinal infection, anterior debridement and posterior fusion can be conducted in cases involving such anatomical limitations.
authors.affiliation: Department of Orthopaedic Surgery, Eniwa Hospital, Eniwa, Japan. yoshim@oak.ocn.ne.jp
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yoshimoto
authors.forename: Shigenobu
authors.initials: S
authors.lastname: Sato
authors.forename: Takahiko
authors.initials: T
authors.lastname: Hyakumachi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yanagibashi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Masuda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000033:anatomy & histology; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000473:pathology; D003646:Debridement; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D010264:Paraplegia / Q000209:etiology; D013123:Spinal Fusion / Q000379:methods*; D013166:Spondylitis / Q000150:complications* / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000473:pathology