Progressive Back Pain due to Aspergillus nidulans Vertebral Osteomyelitis in an Immunocompetent Patient: Surgical and Antifungal Management

Case Report. Aspergillus osteomyelitis is a destructive and progressive infection that has been described both in immunosuppressed and in immunocompetent hosts. We describe a case of lumbar vertebral osteomyelitis in a 61-year-old immunocompetent patient due to Aspergillus nidulans that was successfully treated with a combination of extensive surgical debridement, spinal stabilization, and a prolonged course of antifungal therapy. Imaging demonstrated findings consistent with L3 discitis. The biopsy grew Aspergillus fungus and was treated with vorconizole. Imaging showed progressive destructive osteomyelitis at L3-L4. Patient underwent anterior L3 and L4 partial corpectomies, anterior interbody fusion L3-L5, and posterior T11-S2 pedicle screw and rod fixation. Antifungal treatment resulted in resolution of infection. Aspergillus markers remain negative. One year following definitive treatment, the patient’s back pain remains resolved. Conclusion. Definitive surgical resection of the infection, spinal stabilization, and aggressive antifungal therapy were required to eradicate the infection.

Congenital cervical isthmic spondylolisthesis: A case report

Background: There are only 20 reported cases of cervical isthmic spondylolisthesis in literature that have been surgically managed either anteriorly or posteriorly. Herein, we report such a case managed with circumferential fusion. Case Description: A 27-year-old male became progressively quadriparetic due to cervical isthmic spondylolisthesis at the C6–C7 level. Removal of the posterior arch of C6 with subsequent C5–C7 pedicle screw/rod fixation and anterior interbody fusion resulted in marked recovery and adequate cervical realignment. Conclusion: For patients with cervical isthmic spondylolisthesis, circumferential fusion provides the best surgical option to achieve stability and sagittal balance.