Abstract
In the present case of postoperative lumbar spinal stenosis after non-instrumented intertransverse fusion with granules of hydroxyapatite (HA), bone union was not completed and the patient felt the recurrence of his symptoms within two years. We performed re-decompression with fusion, and in hematoxylin and eosin staining of HA granulation harvested during revision surgery, fibrous tissue with hyaline degeneration surrounded the cavity where the HA had existed. Multinuclear giant cells and lymphocytes infiltrated some parts of the marginal layer of the cavity, and no obvious bony bridge had regenerated from autologous bone. No tartrate-resistant acid phosphate (TRAP) -positive osteoclasts could be seen in the new bone, suggesting that the activity of osteoclasts in the new bone decreased during the seven years after the primary surgery.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3483360258050263
Highlights
In the present case of postoperative lumbar spinal stenosis after non-instrumented intertransverse fusion with granules of hydroxyapatite (HA), bone union was not completed and the patient felt the recurrence of his symptoms within two years
In tartrate-resistant acid phosphate (TRAP) staining, TRAP-positive osteoclasts were not seen in the new bone in spite of the presence of TRAPpositive osteoclasts in the section of the spinous process that was harvested during the surgery (Figure 3)
These findings suggest that the activity of osteoclasts decreased during the seven years after the primary surgery and that insufficient formation of new bone around the HA granules resulted in failure of the intertransverse fusion
Summary
In the present case of postoperative lumbar spinal stenosis after non-instrumented intertransverse fusion with granules of hydroxyapatite (HA), bone union was not completed and the patient felt the recurrence of his symptoms within two years. For his low back and bilateral leg pain, he had undergone L4/L5 non-instrumented intertransverse fusion with granules of HA for lumbar spinal stenosis in another hospital seven years before. * Correspondence: ginoue@kitasato-u.ac.jp 1Department of Orthopaedic Surgery, Kitasato University, School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan Full list of author information is available at the end of the article the T2 wedged axial plane revealed a high intensity area between the mass of hydroxyapatite and the transverse process.
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