PMC6786288_01
Radiographic images from outside hospital. Imaging on presentation from OSH showed a Axial CT imaging demonstrating a large penetrating decubitus ulcer extending into the lumbosacral junction and along the right iliac crest with associated osteomyelitis involving the right iliac crest and sacrum. Additionally, there was evidence of a left ischial ulcer with associated left hip effusion. b Sagittal CT imaging demonstrating complete dissociation of the lumbosacral junction with heterotopic ossification. There is also evidence of complete destruction and collapse of the L4 and L5 vertebrae with partial destruction of L3. c Sagittal CT imaging revealed ballistic bony changes involving T9 -T11 vertebral bodies with a retained ballistic fragment at the T12 soft tissues. d Sagittal 3-dimensional reconstruction of the thoracolumbar spine demonstrating a Charcot joint at the L1-L2 vertebral level with an associated dextroconvexity centered at the destroyed L4-L5 vertebrae
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Fig1
A sacral pressure ulcer extended into the lumbosacral junction causing osteomyelitis of the right iliac crest, L2/L3 vertebral bodies, and sacrum (Fig. 1). Imaging was also notable for complete destruction of the L4 and L5 vertebral bodies, periosteal destruction, and sclerosis of the L3 vertebral body extending into the L2-3 disc space (Fig. 1).
Index surgery post-operative imaging. a Index surgery post-operative CT scout imaging showing posterior thoracolumbar fusion extending from the T2 vertebrae to iliac with associated corpectomy cage at the L4 and L5 levels. b Coronal CT scout imaging demonstrating the right-sided iliac screws situated in the subcutaneous soft tissue overlying the right gluteus maximus. c Axial CT imaging re-demonstrating the pulled-out right-sided iliac screws
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Fig2
All thoracic screws showed greater than 8 mAs and intraoperative O-arm demonstrated appropriate positioning of implants and screws (Fig. 2).
Post-operative revision surgery imaging. CT scout imaging of the revision surgery demonstrating replacement and upsizing of original iliac screws with an additional fusion construct lateral to the original fusion construct extending from the T10 vertebral level to the S2 vertebral level
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Fig3
Imaging revealed pullout of the iliac screw fixation and loss of distraction with the interbody cage (Fig. 3). On HOD 30/POD21, the patient returned to the operating room for a revision T2-iliac posterior spinal fusion with instrumentation, L3-S1 anterior interbody fixation, implantation of new bilateral iliac screw, iliac crest cortoss fixation, and transiliac bar cross link fixation (Fig. 3).