Department of Orthopedic Surgery Case Presentation Jeffrey M

Department of Orthopedic Surgery Case Presentation Jeffrey M. Spivak, MD

The Patient ● 72 F with 3 months thoracolumbar back pain s/p mechanical fall. ● No radiation or paresthesias. No bowel/bladder symptoms or changes in strength/sensation. ● Couldn’t tolerate PT due to pain. No relief with OTC medications. ● No improvement with rigid extension bracing. ● Forward posture but no obvious deformity. ● TTP along midline of thoracolumbar junction. ● Neurologically fully intact. Division of Spine Surgery Department of Orthopedic Surgery

Imaging - XR Division of ________ Department of Orthopedic Surgery

Imaging - MRI 4 Division of ________ Department of Orthopedic Surgery

Treated with Kyphoplasty Division of Spine Surgery Department of Orthopedic Surgery

2 Month S/P Kyphoplasty Department of Orthopedic Surgery

5 Month S/P Kyphoplasty 7 Department of Orthopedic Surgery

7 Month S/P Kyphoplasty ● Presented to ER with 3 days of progressively worsening thoracolumbar pain worse with flexion and lying supine. No radiation. No history of trauma or fevers. No new neurologic symptoms. ● Exam ● Previous surgical sites well healed ● TTP along thoracolumbar junction ● Full strength/sensation ● Labs: WBC 8. 4 / ESR 52 / CRP 29 Division of Spine Surgery Department of Orthopedic Surgery

7 Month S/P Kyphoplasty Department of Orthopedic Surgery

7 Month S/P Kyphoplasty Department of Orthopedic Surgery

7 Month S/P Kyphoplasty T 11 T 12 Department of Orthopedic Surgery

7 Month S/P Kyphoplasty T 11 T 12 12 Department of Orthopedic Surgery

IR Guided Bx ● Samples sent for pathology and cx ● Started on broad spectrum vanc / cefepime Division of Spine Surgery Department of Orthopedic Surgery

Standing XR Division of Spine Surgery Department of Orthopedic Surgery

Surgical Treatment ● Anterior T 11 -T 12 corpectomy, cage reconstruction. ● T 9 -L 2 Posterior instrumented fusion and fixation. Division of Spine Surgery Department of Orthopedic Surgery

Postoperative Course ● Discharged to SAR POD 10 on IV Vanc / CTX for 6 week course ● Final Pathology: chronic inflammatory changes consistent with chronic osteomyelitis, negative for malignancy ● Final Cx: no growth Division of Spine Surgery Department of Orthopedic Surgery

2 Weeks Postop Department of Orthopedic Surgery

6 Months Postop Department of Orthopedic Surgery