title: Posterior-Only Circumferential Decompression and Reconstruction in the Surgical Management of Lumbar Vertebral Osteomyelitis.
abstract: Study Design Case report. Objective The purpose of this report is to discuss the surgical management of lumbar vertebral osteomyelitis with a spinal epidural abscess (SEA) and present a single-stage, posterior-only circumferential decompression and reconstruction with instrumentation using an expandable titanium cage and without segmental nerve root sacrifice as an option in the treatment of this disease process. Methods We report a 42-year-old man who presented with 3 days of low back pain and chills who rapidly decompensated with severe sepsis following admission. Magnetic resonance imaging of his lumbosacral spine revealed intramuscular abscesses of the left paraspinal musculature and iliopsoas with SEA and L4 vertebral body involvement. The patient failed maximal medical treatment, which necessitated surgical treatment as a last resort for infectious source control. He underwent a previously undescribed procedure in the setting of SEA: a single-stage, posterior-only approach for circumferential decompression and reconstruction of the L4 vertebral body with posterior segmental instrumented fixation. Results After the surgery, the patient's condition gradually improved; however, he suffered a wound dehiscence necessitating a surgical exploration and deep wound debridement. Six months after the surgery, the patient underwent a revision surgery for adjacent-level pseudarthrosis. At 1-year follow-up, the patient was pain-free and off narcotic pain medication and had returned to full activity. Conclusion This patient is the first reported case of lumbar osteomyelitis with SEA treated surgically with a single-stage, posterior-only circumferential decompression and reconstruction with posterior instrumentation. Although this approach is more technically challenging, it presents another viable option for the treatment of lumbar vertebral osteomyelitis that may reduce the morbidity associated with an anterior approach.
authors.affiliation: Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York, United States.
authors.forename: Branko
authors.initials: B
authors.lastname: Skovrlj
authors.affiliation: Department of Orthopaedics, Mount Sinai School of Medicine, New York, New York, United States.
authors.forename: Javier Z
authors.initials: JZ
authors.lastname: Guzman
authors.affiliation: Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York, United States.
authors.forename: John
authors.initials: J
authors.lastname: Caridi
authors.affiliation: Department of Orthopaedics, Mount Sinai School of Medicine, New York, New York, United States.
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Cho
keywords: circumferential decompression and reconstruction; lumbar vertebral osteomyelitis; posterior-only approach; spinal epidural abscess
references.citation: J Neurosurg. 1996 Aug;85(2):211-20
references.pmid: 8755748
references.citation: Spine (Phila Pa 1976). 2009 Jan 1;34(1):E33-40
references.pmid: 19127146
references.citation: Rev Esp Cir Ortop Traumatol. 2014 May-Jun;58(3):182-91
references.pmid: 24703108
references.citation: Spine (Phila Pa 1976). 1997 Jul 15;22(14):1568-72; discussion 1573
references.pmid: 9253090
references.citation: Spine (Phila Pa 1976). 2000 Sep 1;25(17):2240-9,discussion 250
references.pmid: 10973409
references.citation: Eur Spine J. 2013 Mar;22(3):633-41
references.pmid: 22922802
references.citation: Spine (Phila Pa 1976). 2002 Nov 1;27(21):2374-82
references.pmid: 12438987
references.citation: Asian Spine J. 2011 Sep;5(3):155-61
references.pmid: 21892387
references.citation: Spine J. 2014 Feb 1;14(2):326-30
references.pmid: 24231778
references.citation: Eur Spine J. 2012 Jan;21(1):84-92
references.pmid: 21681631
references.citation: Br J Neurosurg. 2008 Feb;22(1):92-8
references.pmid: 18224528
references.citation: Acta Neurochir (Wien). 2014 Apr;156(4):749-54
references.pmid: 24570187
references.citation: Spine (Phila Pa 1976). 2009 Apr 15;34(8):822-6
references.pmid: 19365252
references.citation: J Emerg Med. 2004 Apr;26(3):285-91
references.pmid: 15028325
references.citation: J Neurosurg Sci. 2008 Dec;52(4):101-6; discussion 106
references.pmid: 18981984
references.citation: Neurosurg Rev. 2000 Dec;23(4):175-204; discussion 205
references.pmid: 11153548
references.citation: Spine (Phila Pa 1976). 2014 Jan 15;39(2):177-84
references.pmid: 24158179
references.citation: Spine (Phila Pa 1976). 2012 Jul 15;37(16):1375-83
references.pmid: 22391438
references.citation: J Spinal Disord Tech. 2011 Apr;24(2):110-5
references.pmid: 21445024
references.citation: J Neurosurg Spine. 2004 Oct;1(3):287-98
references.pmid: 15478367
references.citation: Spine (Phila Pa 1976). 2005 Dec 1;30(23):E703-10
references.pmid: 16319740
references.citation: Surg Neurol. 1999 Aug;52(2):189-96; discussion 197
references.pmid: 10447289
references.citation: N Engl J Med. 2006 Nov 9;355(19):2012-20
references.pmid: 17093252
references.citation: J Spinal Disord Tech. 2015 Dec;28(10):E584-9
references.pmid: 24189484
references.citation: Curr Infect Dis Rep. 2010 Nov;12(6):484-91
references.pmid: 21308559
references.citation: Neurosurg Focus. 2003 Nov 15;15(5):E8
references.pmid: 15323465
references.citation: World Neurosurg. 2014 Dec;82(6):e807-14
references.pmid: 24937598