PMC4585130_01
Patient 1. A 67-year-old woman with severe back pain presented after medical treatment of a polymicrobial sacral decubitus ulcer. Sagittal T1-weighted magnetic resonance images of the lumbar spine with (A) and without (B) contrast demonstrated PVDO at L4-L5-S1 with involvement of the vertebral bodies and endplates. L4-L5 spondylodiscitis with anterolisthesis was present as well as epidural and prevertebral abscesses. Preoperative upright radiographs before (C) and 1 month after (D) antibiotic therapy demonstrate progression from Grade I to Grade II L4-L5 anterolisthesis. Posterior-only decompression and fusion without formal debridement of the infected tissues was performed with pedicle screws at L2, L3, right L4, and S1 combined with S2AI screws (E,F); poor bone quality precluded instrumentation at L4 on the left and at L5. At 2 years, sagittal (G) and coronal (H) CT reconstructions demonstrate stable fusion at the lumbosacral junction.
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F1
Imaging demonstrated PVDO of L4-L5-S1 with endplate erosion, L4-L5 spondylodiscitis with anterolisthesis, and collapse of the L4-L5 and L5-S1 disk spaces (Figure 1).