Minim Invasive Neurosurg 2010; 53(2): 80-82
DOI: 10.1055/s-0030-1249682
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Combined Surgical and Radiosurgical Treatment of Symptomatic Aggressive Vertebral Osteomyelitis

S. Zausinger1 , K. Schoeller1 , T. Arzberger2 , A. Muacevic3
  • 1Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
  • 2Department of Neuropathology, Ludwig-Maximilians-University, Munich, Germany
  • 3European Cyberknife Centre, Munich, Germany
Further Information

Publication History

Publication Date:
08 June 2010 (online)

Abstract

Introduction: The surgical treatment of vertebral osteomyelitis can be complicated by severe additional diseases or the need for extensive debridement with concomitant risks. We report a case of combined surgical and radiosurgical treatment of idiopathic vertebral osteomyelitis of L4.

Case Report: The patient presented with progressive enlargement of the right side of the vertebral body L4 due to chronic fibrous osteomyelitis without evidence of infection, leading to compression of nerve roots L4, L5 and the dural sac with resulting radicular paresis. During decompression of the nerve roots via a dorsal approach, massive bleeding from the inflammatory vertebral body occurred, making abortion of surgery necessary. Remnant inflammatory masses of vertebral body L4 were treated by spinal robotic radiosurgery with a high tumoricidal dose of 20 Gy without clinical and radiological signs of relapse of disease in the following three years.

Conclusion: We describe a case of the combined surgical and radiosurgical treatment of lumbar osteomyelitis with symptomatic nerve root compression. Dorsal decompression followed by spinal radiosurgery for the anterior vertebral parts with avoidance of potentially dangerous anterior spondylectomy led to a rapid improvement of paresis and pain with persistent control of vertebral inflammation and enlargement. The described case of close cooperation of surgeons and radiosurgeons offered an effective and functionality preserving treatment in this challenging case.

References

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Correspondence

PD Dr. S. Zausinger

Department of Neurosurgery

Ludwig-Maximilians-University

Klinikum Grosshadern

Marchioninistraße 15

81377 Munich

Germany

Phone: +49/89/7095 2590

Fax: +49/89/7095 2592

Email: Stefan.Zausinger@med.uni-muenchen.de

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