Posterior Lumbar Arthrodesis Using a Stand-Alone Hydrophilic Synthetic Bone Graft in the Setting of Postoperative Osteomyelitis/Discitis: A Case Report
Abstract
This single-patient case report describes an all-posterior salvage reconstruction of multilevel lumbar osteomyelitis using a stand-alone hydrophilic synthetic bone graft (HPSBG; OsteoFlo® HydroFiber™, SurGenTec, LLC, Boca Raton, FL) packed transpedicularly as the sole intervertebral graft material. Postoperative osteomyelitis with progressive vertebral body destruction commonly involves combined anterior-posterior reconstruction with corpectomy and structural cage placement, which is technically demanding and morbid in patients with poor bone quality and adjacent prior fractures. Hydrophilic synthetic bone grafts engineered to support fusion in compromised environments may permit less invasive salvage strategies. A 59-year-old woman with persistent L1-L2 osteomyelitis after a prior L2-L5 fusion for an L3 burst fracture, complicated by osteoporosis and low vitamin D levels (25-hydroxyvitamin D 15.6 ng/mL), underwent posterior-only salvage reconstruction. Through an all-posterior approach, transpedicular partial corpectomies of L1 and L2 were performed through the existing erosive defects. Intraoperative cultures grew Pseudomonas aeruginosa. The void was packed with HPSBG as the sole intervertebral graft material, with no anterior cage. Long-segment T10-pelvis fixation with a quad-rod construct provided posterior stabilisation. Computed tomography (CT) at eight months postoperatively demonstrated bridging bone through the L1-L2 defect, consistent with early anterior column…
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