Posterior Lumbar Arthrodesis Using a Stand-Alone Hydrophilic Synthetic Bone Graft in the Setting of Postoperative Osteomyelitis/Discitis: A Case Report.

This single-patient case report describes an all-posterior salvage reconstruction of multilevel lumbar osteomyelitis using a stand-alone hydrophilic synthetic bone graft (HPSBG; OsteoFlo® HydroFiber™, SurGenTec, LLC, Boca Raton, FL) packed transpedicularly as the sole intervertebral graft material. Postoperative osteomyelitis with progressive vertebral body destruction commonly involves combined anterior-posterior reconstruction with corpectomy and structural cage placement, which is technically demanding and morbid in patients with poor bone quality and adjacent prior fractures. Hydrophilic synthetic bone grafts engineered to support fusion in compromised environments may permit less invasive salvage strategies. A 59-year-old woman with persistent L1-L2 osteomyelitis after a prior L2-L5 fusion for an L3 burst fracture, complicated by osteoporosis and low vitamin D levels (25-hydroxyvitamin D 15.6 ng/mL), underwent posterior-only salvage reconstruction. Through an all-posterior approach, transpedicular partial corpectomies of L1 and L2 were performed through the existing erosive defects. Intraoperative cultures grew Pseudomonas aeruginosa. The void was packed with HPSBG as the sole intervertebral graft material, with no anterior cage. Long-segment T10-pelvis fixation with a quad-rod construct provided posterior stabilisation. Computed tomography (CT) at eight months postoperatively demonstrated bridging bone through the L1-L2 defect, consistent with early anterior column consolidation, and repeat CT at 12 months showed bridging trabecular bone across the defect with continuity to the host endplates. Patient-reported outcomes improved at 12 months, and the patient returned to her preoperative activities. This case suggests that a stand-alone hydrophilic synthetic graft may support anterior column consolidation when used without an interbody cage in an infected, biologically hostile environment, potentially reducing the need for morbid anterior reconstruction in selected salvage cases. Larger comparative studies are warranted.