1. INTRODUCTION
Since infectious spondylitis usually affects the vertebral bodies and
intervertebral disc(s), curettage of those lesions and anterior spinal
fusion have been the treatment of choice.1 In the
thoracic spine, thoracotomy is the standard approach for this surgical
purpose; however, the procedure may exert considerable stress on lung
function. Anterior debridement through a posterolateral approach was
first described by Capener as “lateral rhachotomy” for tuberculous
spondylitis in 1954.2 We also reported good surgical
outcomes following a single-stage combination of lateral rhachotomy and
posterior spinal fusion using a compression hook system for tuberculous
spondylitis.3
Recently, a percutaneous pedicle screw (PPS) system has enabled a
minimally invasive but rigid posterior spinal fusion for infectious
spondylitis outside the infected lesion.4 PPSs can be
inserted in a separate tract from the curettage site of lateral
rhachotomy, preventing contamination of the implants. Here, we report a
case of thoracic pyogenic spondylitis that was successfully treated with
single-stage posterior fixation using PPSs in combination with curettage
and autogenous iliac bone grafting of the vertebral bodies with
bilateral, separated posterolateral approaches.