A case of spondylitis caused by SAPHO syndrome treated with oblique lateral interbody fusion

Abstract

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome sometimes accompanies destructive spinal disorder, and some reports suggest that fusion is favorable when spinal instability is observed. To report a case of spondylitis caused by SAPHO syndrome treated with oblique lateral body fusion (OLIF).A 65-year-old woman with a chief complaint of low back pain, which caused her bedridden state, presented to our hospital. She did not have neurological symptoms in her legs. Plain radiographic imaging revealed osteosclerotic changes at the T11, T12, L3, and L4 vertebrae and a destructive lesion at the bony end plate of T11/12, L3/4, and L4/5. Her white blood cell count was 6100 μL and C-reactive protein level was 0.98 mg/dL. Results of the biopsies for the L4 vertebral body and L4/5 disk were negative for common bacteria and acid-fast bacilli. Rashes on both palms and pain in the scapular and breast bone occurred during the follow-up period. Accumulation was observed in the sternoclavicular joint and thoracolumbar spine on bone scintigraphy; thus, SAPHO syndrome was diagnosed. OLIF for L3/4 and L4/5 were performed, but the back pain was not improved. Then, secondary surgery for the posterior fusion of T11/12 and percutaneous pedicle screw placement for L3-L4-L5 were performed. Her low back pain was improved postoperatively, and self-walking became possible. After 1 year of operation, no back pain and good bone fusion were observed. Lumbar stability was achieved using less-invasive methods, including OLIF and percutaneous pedicle screw placement. In conclusion, lateral interbody fusion such as OLIF could be a surgical option for lumbar instability caused by SAPHO syndrome.

Keywords

• SAPHO syndrome
• Spondylitis
• Oblique lateral body fusion
• Instability
• Percutaneous pedicle screw