Minimally invasive lateral transpsoas approach for spinal discitis and osteomyelitis.

We present a series of patients with discitis and osteomyelitis who were surgically treated via a minimally invasive lateral transpsoas approach to the lumbar spine. Surgical treatment for spinal discitis and osteomyelitis presents challenges because of comorbidities that are common in patients undergoing this procedure. A retrospective review found six patients who met strict operative criteria including instability, intractable pain, neurological deficit, and disease progression. All patients were non-ambulatory before surgery because of intractable back pain. The patients underwent standard lateral minimally invasive surgery using either the extreme lateral interbody fusion (NuVasive, San Diego, CA, USA) or direct lateral interbody fusion (Medtronic Sofamor Danek, Memphis, TN, USA) system. The patients underwent debridement with a discectomy and partial or complete corpectomy, with polyetheretherketone or titanium cage placement. Two patients had additional posterior fixation with percutaneous pedicle screws, and none had immediate perioperative complications. The postoperative CT scans demonstrated satisfactory debridement and hardware placement. All patients experienced significant pain improvement and could ambulate within a few days of surgery. So far, the 1 year follow-up data have demonstrated stable hardware with solid fusion and continued pain improvements. One patient demonstrated hardware failure secondary to refractory infection, 2 months postoperatively, and required additional posterior decompression and debridement with pedicle screw fixation. The lateral transpsoas approach permits debridement and fixation coupled with percutaneous pedicle screw fixation to further stabilize the spine in a minimally invasive fashion. Due to the significant comorbidities in this patient population, a minimally invasive approach is a suitable surgical technique. A close follow-up period is necessary to detect early hardware failure which may necessitate more extensive treatment.

Cranial reconstruction for treatment of intracranial hypertension from sclerosteosis: case-based update.

BACKGROUND: Sclerosteosis (OMIM 269500) is a progressive, autosomal recessive, sclerosing bone disorder with a well defined phenotype. This phenotype is correlated with a deficiency in the protein product sclerostin, leading to bony overgrowth from the loss of inhibition of osteocyte function. Calvarial overgrowth can lead to cranial nerve palsies, visual impairment, and compression of the medulla at the foramen magnum. There is a presumption that calvarial thickening may lead to elevated intracranial pressure in these patients, although pressure measurements have not been published. CASE DESCRIPTION: The authors report the case of a 28-year-old Saudi Arabian man with sclerostosis, progressive headaches, and a cervical spinal cord syrinx. A cranial reconstruction was performed by aggressively thinning the thickened cortical bone, thereby expanding the intracranial space. The measured intracranial pressure was 25-40 mm HG under anesthesia. CONCLUSIONS: After surgery, the patient had resolution of the headaches and radiographic near-resolution of the syrinx. The authors review their experience and the relevant literature with this rare case.