Combined Surgical and Radiosurgical Treatment of Symptomatic Aggressive Vertebral Osteomyelitis

Introduction: The surgical treatment of verte- bral 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 pro- gressive enlargement of the right side of the vertebral body L4 due to chronic fi brous osteo- myelitis without evidence of infection, leading to compression of nerve roots L4, L5 and the dural sac with resulting radicular paresis. Dur- ing decompression of the nerve roots via a dorsal approach, massive bleeding from the infl amma- tory vertebral body occurred, making abortion of surgery necessary. Remnant infl ammatory masses of vertebral body L4 were treated by spi- nal 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 com- bined surgical and radiosurgical treatment of lumbar osteomyelitis with symptomatic nerve root compression. Dorsal decompression fol- lowed 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 infl ammation and enlarge- ment. The described case of close cooperation of surgeons and radiosurgeons off ered an eff ective and functionality preserving treatment in this challenging case.