Distal Junctional Failure due to Spondylodiscitis in a Patient with Long Posterior Fixation for Ossified Longitudinal Ligament and Ossified Ligamentum Flavum

Kavinan, A L Subramaniam and Tey Shen, Liang and Phang Zi, Hao and Nur Aida, Faruk Senan and Mohamad Zaki, Haji Mohd Amin and Mantu, Jain (2024) Distal Junctional Failure due to Spondylodiscitis in a Patient with Long Posterior Fixation for Ossified Longitudinal Ligament and Ossified Ligamentum Flavum. Journal of Orthopaedic Case Reports 2024 March:14(3):Page 141-145, 14 (3). pp. 141-145. ISSN 2250 – 0685

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Abstract

Introduction: Distal junctional failure (DJF) is underreported when compared to proximal junctional failure. DJF arising due to spondylodiscitis has never been reported in the literature. Case Report: A 45-year-old lady with a body mass index of 33 presented with a long-standing inability to walk due to myelopathy secondary to continuous ossified posterior longitudinal ligament and ossified ligamentum flavum. Posterior fusion and laminectomy were done from D2 to L2. She had an initial wound breakdown with a surgical site infection, but after 6 weeks, she developed spondylodiscitis at the distal instrumented vertebra, leading to DJF. She was started on appropriate antibiotics and an extension of fusion. Conclusion: This report demonstrates and discusses the management of a rare case of DJF arising due to spondylodiscitis of the last instrumented vertebra. Keywords:Junctional failure, distal, spondylodiscitis, surgical site infection

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