Lumbar Spine Coccidioidomycosis Osteomyelitis Requiring Lumbo-Pelvic Reconstruction

Coccidioidomycosis of the spine is rare, and coccidioidomycosis osteomyelitis of the spine requiring surgery is even more infrequent. Here, we report a case of spinal coccidioidomycosis. The case involves a 22-year-old African-American woman from the Central Valley of California with a 2-year history of disseminated coccidioidomycosis presented with back and leg pain secondary to L4-5 osteomyelitis. In this patient with coccidioidomycosis osteomyelitis, magnetic resonance imaging, and computed tomography scans showed extensive lumbar vertebral body involvement and collapse with spinal canal compromise. The patient underwent an L4-5 corpectomy with expandable cage placement followed by posterior L2 to ilium fixation and fusion. On follow-up, the patient has good radiographic evidence of fusion and was pain-free, ambulating, and without evidence of infection 2 years after surgery. To our knowledge, there has not been a reported case of coccidioidomycosis osteomyelitis with extreme deformity and pelvic obliquity treated by corpectomy and lumbopelvic reconstruction. Dissemination of coccidioidomycosis to the spine is rare but known. Extensive destruction to the lower lumbar spine may require aggressive multilevel corpectomy with reconstruction. Placement of bilateral iliac screws can augment stability and promote fusion in patient with lower lumbar osteomyelitis.

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