Temporary standalone percutaneous fixation with pedicle screws for the treatment of subacute tuberculous osteomyelitis with kyphotic deformity in the lumbar spine.

Background: Tuberculous (TB) osteomyelitis is a rare, but challenging infection, that mandates antituberculosis antibiotics, and potentially surgical intervention. Per the Gulhane Askeri Tip Akademisi (GATA) classification system, corrective reconstruction is indicated in severe cases, where the kyphotic deformity is >20° (GATA Class III). Here, we describe a case of BCG vaccine-induced lumbar TB osteomyelitis at the L1-2 level in a patient presenting with mechanical pain and a focal, nonfixed kyphotic deformity of 36.1°. Surgery consisted of percutaneous fixation with pedicle screws without debridement, fusion arthrodesis, or anterior reconstruction. Case Description: A 77-year-old male presented with L1-2 TB osteomyelitis secondary to intravesical BCG application. A 36.1° focal nonfixed kyphotic deformity was evident on standing X-rays that reduced in the supine position. He underwent posterior percutaneous screw fixation with rods extending from the T12 to L3 levels, with resolution of his mechanical pain. Nine months later, the CT demonstrated reconstitution of the vertebral bodies (i.e., volume increase of 6.99 cm3 (21%) and 7.49 cm3 (27%) at L1 and L2, respectively). Standing X-rays after hardware removal demonstrated 32.7° of lumbar lordosis and a reduction of focal kyphosis to 12.9°. Conclusion: Here, we present an exceedingly rare case of BCG vaccine-induced L1-2 spinal tuberculosis with extensive vertebral body destruction and deformity. This was effectively treated with standalone temporary pedicle fixation instead of corpectomy and reconstruction.

Basilar artery incarceration secondary to a longitudinal clivus fracture: A rare and favorable outcome of an often devastating injury.

Background: Clival fractures are a rare traumatic finding and are often the result of high-impact craniofacial trauma. Rarely, longitudinal clival fractures can be associated with incarceration of the basilar artery within the fracture and/or the sphenoid sinus. Of the 12 reported cases of basilar incarceration, 11 of these injuries have proved to be fatal due to pontine infarction. We present a patient with basilar artery incarceration without any neurologic deficits. Case Description: The case reported is a 17-year-old male who presented after a motor vehicle collision with a linear and longitudinal clival fracture with entrapment of the basilar artery within the sphenoid sinus. Diagnostic subtraction angiography showed a small intimal tear with possible intraluminal thrombus. The patient was started on aspirin and at 3-month post injury had no neurologic deficits. Conclusion: Basilar artery incarceration is an injury often associated with pontine infarction secondary to basilar artery dissection and/or thrombus developing at the site of entrapment. Our case illustrates a favorable outcome after this injury. Based on these results, antiplatelet therapy may be a viable option for prevention of brainstem infarcts in patients with this injury; however, further prospective studies must be done to assess the overall efficacy and validity of this treatment. There are no established treatment guidelines for this condition. Further research on this topic should also be tailored toward early identification of this pathology and prevention of thromboembolic sequelae of this injury.