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.