Fall 2011 Issue

Lifesaving Procedure For Treating Cervical Spinal Infection Developed By Practice Neurosurgeon
Case Featured In Journal of Neurosurgery: Spine

Advanced spinal infections can be insidious, weakening the spine, causing paralysis and eventually death. The conventional approach to spinal infection surgery mandates removal of three to four vertebrae around the infected area and reconstruction of the spine using instrumentation and fusion. Infections in the neck area, or cervical spine, have typically been viewed as inoperable.

Now there is a new, minimally invasive option for treating cervical spine infections, developed by Carolina Neurosurgery & Spine Associates neurosurgeon Vinay Deshmukh, MD, FACS, as described in the August 2010 issue of Journal of Neurosurgery: Spine. This approach is much less invasive and requires no hardware or spinal fusion.

Dr. Deshmukh first developed the new minimally invasive approach to accessing cervical spine infections when treating a 59-year-old woman with a history of a chronic, nonhealing skin ulcer. She presented with sepsis, neck pain, and rapidly progressing weakness in her arms and legs. MRI studies revealed a multifocal ventral, cervical, and upper thoracic spinal epidural abscess. The abscess was creating spinal compression behind the disc space of C2-3 and C7-T1. Because of the patient’s rapidly deteriorating condition, Dr. Deshmukh implemented an innovative, minimally invasive approach to accessing the infection.

“I used a small drill to create a trough corpectomy in the vertebrae to reach the infection site,” said Dr. Deshmukh. “We were then able to clear out the infection and spare the majority of bone in the infected region.” Rapid and successful decompression of the entire ventral cervical and upper thoracic epidural space was achieved using this trough corpectomy technique.

After the procedure, the patient was immobilized in a cervical collar and closely monitored using CT scans and MRI. She also received post-op antibiotic treatment. Neuroimaging studies confirmed complete resolution of the abscess. At the 12-month follow-up, the patient had returned to work and showed no signs of paralysis.

This new technique takes only 60 to 90 minutes to complete, requires no hardware or fusion, and estimated blood loss is only ¼ pint. This is dramatically different than the traditional treatment, which requires removal of vertebrae, takes five to seven hours, and can lead to blood loss of 1 ½ liters.

“Many surgeons would have considered this to be an untreatable condition. The prevailing wisdom is that serious infections cannot be treated this way,” said Dr. Deshmukh. “Fortunately, this case shows that a trough corpectomy is a viable surgical approach for cervical spinal infections. We hope that more patients will now benefit as other surgeons become aware of this option.”

To learn more about spine care and physical therapy services at Carolina Neurosurgery & Spine Associates, call 800-344-6716.

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