Postoperative Course: Minimal Access Spinal Technology (MAST) Fusion for Osteomyelitis

Postoperative Course

The patient was well postoperatively and mobilized 48 hours after surgery in a brace. His mechanical pain had improved dramatically. His upright x-rays and CT scans at L2 and L4 are shown below and showed no adverse features (Figures 9, 10a, 10b):

He was discharged on oral antibiotics 2 weeks later. At last follow-up, 4 weeks after surgery, he remained pain free with no evidence of kyphosis on imaging.

Discussion

Discitis and osteomyelitis leads to loss of structural strength of the vertebral body. With the loss of posterior elements from previous surgery gross instability can result. In patients who would not tolerate major spinal reconstruction, prolonged bedrest may be associated with significant morbidity and potential mortality. In this sort of scenario, being able to provide structural stability through a posterior tension band can lead to eventual fusion across the involved segments. This approach has been described before in the face of osteomyelitis, where pedicle screw fusion alone has lead to stability and eventual fusion (1). The application of minimally-invasive technology to this however is a new approach. By using MAST® techniques and the Sextant® apparatus, stabilization for osteomyelitis was effected in a patient who otherwise may not have been fit for any surgical endeavour.

The use of minimally-invasive approaches to spinal instrumentation is an exciting new technology that will allow surgery to be performed in patients who previously unfit for surgical intervention. Aside from degenerative disease, this case illustrates a novel approach to the stabilisation of the spine in the face of serious infection in a patient unfit for a major intervention.

References

1. Karlsson MK, Hasserius R, Olerud C, Ohlin A: Posterior transpedicular stabilisation of the infected spine. Arch Orthop Trauma Surg 2002 Dec;122(9-10):522-57.