L5 vertebral osteomyelitis treated with L5 corpectomy and anterior instrumentation: case report

STUDY DESIGN  A case report. OBJECTIVE  Pyogenic osteomyelitis is the most common form of vertebral infection and typically resolves following conservative treatment with antibiotics administered long term and immobilization. In cases of spinal instability, severe neurological deficit or disease refractory to medical management, neurosurgical intervention is warranted. Historically, these patients have undergone radical vertebral debridement and grafting with or without posterior instrumentation. We report the case of a 46-year-old female intravenous drug user presenting with L5 pyogenic osteomyelitis with L5 vertebral compression and cortex retropulsion following L2-L4 laminectomy for epidural abscess 8 weeks prior. METHODS  The patient underwent an anterior approach single-stage L5 corpectomy, L4/5 and L5/S1 discectomies, expandable titanium-cage insertion and anterior plating from L4 to the sacrum. RESULTS  The patient recovered without any complications. The infection was successfully eradicated and her fusion remains solid 18 months postoperatively. CONCLUSIONS  To our knowledge, this is the first case of L5 vertebral osteomyelitis treated with a single-stage corpectomy and anterior instrumentation.