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Case Presentation

This case presentation discusses a 72-year-old female patient with thoracolumbar back pain and the surgical treatment of thoracolumbar osteomyelitis. The patient underwent anterior corpectomy and posterior instrumented fusion with favorable postoperative outcomes.

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Case Presentation

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Presentation Transcript

  1. Department of Orthopedic Surgery Case Presentation Jeffrey M. Spivak, MD

  2. The Patient • 72F with 3 months thoracolumbar back pain s/p mechanical fall. • No radiation or paresthesias. No bowel/bladder symptoms or changes in strength/sensation. • Couldn’t tolerate PT due to pain. No relief with OTC medications. • No improvement with rigid extension bracing. • Forward posture but no obvious deformity. • TTP along midline of thoracolumbar junction. • Neurologically fully intact. Division of Spine Surgery

  3. Imaging - XR Division of ________________

  4. Imaging - MRI Division of ________________

  5. Treated with Kyphoplasty Division of Spine Surgery

  6. 2 Month S/P Kyphoplasty

  7. 5 Month S/P Kyphoplasty

  8. 7 Month S/P Kyphoplasty • Presented to ER with 3 days of progressively worsening thoracolumbar pain worse with flexion and lying supine. No radiation. No history of trauma or fevers. No new neurologic symptoms. • Exam • Previous surgical sites well healed • TTP along thoracolumbar junction • Full strength/sensation • Labs: WBC 8.4 / ESR 52 / CRP 29 Division of Spine Surgery

  9. 7 Month S/P Kyphoplasty

  10. 7 Month S/P Kyphoplasty

  11. T11 7 Month S/P Kyphoplasty T12

  12. T11 7 Month S/P Kyphoplasty T11 T12 T12

  13. IR Guided Bx • Samples sent for pathology and cx • Started on broad spectrum vanc / cefepime Division of Spine Surgery

  14. Standing XR Division of Spine Surgery

  15. Surgical Treatment • Anterior T11-T12 corpectomy, cage reconstruction. • T9-L2 Posterior instrumented fusion and fixation. Division of Spine Surgery

  16. Postoperative Course • Discharged to SAR POD10 on IV Vanc / CTX for 6 week course • Final Pathology: chronic inflammatory changes consistent with chronic osteomyelitis, negative for malignancy • Final Cx: no growth Division of Spine Surgery

  17. 2 Weeks Postop

  18. 6 Months Postop

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