Novel minimally invasive management of lumbar osteomyelitis: A case report.

INTRODUCTION AND IMPORTANCE: Vertebral osteomyelitis is a rare disease that might lead to significant clinical problems. Initially, conservative therapy is considered to be sufficient for most patients. However, it is not uncommon that the infectious process may become fulminant and severe complications could arise. Recent studies have shown that percutaneous endoscopic debridement provides a favorable outcome in managing lumbar infections without severe neurological symptoms. CASE PRESENTATION: We presented a case report of a female, 49 years old, with pyogenic vertebral osteomyelitis of the 4th - 5th lumbar spine without neurologic deficit. X-ray examination showed a resemblance of the lytic lesion over the anterior aspect of the L4. We then planned a minimally invasive endoscopic procedure for the patient. We made the 1st portal to aspirate the abscess product and for the endoscopy instrument to debride the remaining debris material. We also developed the second portal using kyphoplasty needl towards the pedicle to gain access to the vertebral body. The debriding process was achieved by positive irrigation pressure from one portal to another using physiologic NaCl saline and gentamicin solution. CLINICAL DISCUSSION: Combined with the access created by the kyphoplasty needle, more thorough irrigation was made possible as the intravertebral body was approachable. Compared to open surgery, this approach can reduce surgical damage. Clinically, patient experienced an almost instant relief of pain. CONCLUSION: Percutaneous endoscopic debridement technique in addition of kyphoplasty needle allows wider area for adequate debridement and better result, while maintaining minimally invasive setting with minimum complications.

Pelvic parameter improvement following deformity correction in adolescence idiopathic scoliosis: A case series.

INTRODUCTION: Scoliosis is defined as 3-dimensional deformity of the spine with lateral deviation more than 10° and rotation of the vertebrae. Adolescence idiopathic scoliosis (AIS) is scoliosis that affect children between the age of 11-18 years old without any identifiable cause or underlying disease. PRESENTATION OF CASE: This study will compare the pelvic parameters and functional score of the patients before and after the procedure. Pelvic parameters are represented by 3 angles: pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) of 5 adolescence idiopathic scoliosis patients. Functional outcomes were evaluated using Indonesian SF-36 questionnaire and also pain scale of preoperative and postoperative. DISCUSSION: An important outcome of this study was a statistically significant improvement in coronal alignment, functional capacity, pain, and role of limitation due to physical health. Coronal angle deformity correction of AIS patients is correlated with sagittal improvement which caused by compensatory alteration of pelvic parameter. CONCLUSION: This finding correlates with the improvement of functional outcome of the patients.