PMC9577107_01
Preoperative standing x-ray prior to index surgery: anteroposterior view (left) and lateral view (right).
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F1
A 64-year-old woman with history a of chronic obstructive pulmonary disease, asthma, elevated arterial blood pressure, eczematous dermatitis, and alcohol abuse was operated on at our institution for decompression with posterolateral L2-L4 instrumented fusion, due to stenosis and spondylolisthesis of L3 (Figures 1, 2).
Evaluation of lumbar spine motion with dynamic x-ray prior to index surgery: flexion view (left) and extension view (right).
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F2
A 64-year-old woman with history a of chronic obstructive pulmonary disease, asthma, elevated arterial blood pressure, eczematous dermatitis, and alcohol abuse was operated on at our institution for decompression with posterolateral L2-L4 instrumented fusion, due to stenosis and spondylolisthesis of L3 (Figures 1, 2).
Emergent MRI demonstrated pyogenic spondylodiscitis with paraspinal and epidural purulent collection at the level of spondylodesis L2 to L4 (A,D) with total spinal stenosis at the L4 level (B,E). Concomitant purulent collections, without neurologic compromise, from the Th4 to Th12 level (C,F). The follow-up imaging revealed residual fluid collections in the paraspinal soft tissue and right psoas muscle, with regression of spondylodiscitis, resolution of total spinal stenosis at the L4 level (G,H), and evidence of bone fusion with postoperative deformity at the level of surgery (I).
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F3
Emergent MRI demonstrated pyogenic spondylodiscitis with paraspinal and epidural purulent collection at the level of spondylodesis L2-L4 with total spinal stenosis at the L4 level (Figure 3). Concomitant purulent collections, without neurologic compromise, were seen at the Th4-Th12 levels and in the right psoas muscle (Figure 3). The follow-up imaging revealed residual fluid collections in the paraspinal soft tissue and right psoas muscle, with regression of spondylodiscitis, resolution of total spinal stenosis at the L4 level, and evidence of bone fusion with postoperative deformity at the level of surgery (Figure 3).
At the last follow-up, 4 years after the second surgery, the patient was still complaining of low back pain but was manageable with conservative methods, despite radiological progression of deformity: anteroposterior view (left) and lateral view (right).
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F4
At the last follow-up, 4 years after the second surgery, the patient was still complaining of low back pain but was manageable with conservative methods, despite radiological progression of deformity (Figure 4).