Clin Orthop Surg.  2011 Sep;3(3):254-257. 10.4055/cios.2011.3.3.254.

Chronic Osteomyelitis of the Lumbar Transverse Process

• Lee BJ
• Kim ST
• Yoon MG
• Kim SS
• Moon MS

• KMID: 1743918
• DOI: http://doi.org/10.4055/cios.2011.3.3.254

Abstract

Pyogenic spondylitis involving only the posterior element of a vertebra is rare. To the best of our knowledge, there have been no reports of osteomyelitis of the transverse process. We report here on a 45-year-old male with a one month history of swelling associated with lower back pain. The magnetic resonance imaging showed a paraspinal soft tissue mass, and computed tomography revealed a fine osteolytic lesion in the right transverse process of the 5th lumbar spine, and this was all consistent with chronic osteomyelitis. A mixed staphylococcal infection was identified. Open drainage, resection of the transverse process and intravenous injection of anti-staphylococcal antibiotics resolved the back pain and reduced the erythrocyte sedimentation rate to normal. Pyogenic osteomyelitis of the transverse process is extremely rare, which can cause a misdiagnosis or a delayed diagnosis. Careful consideration of this disease is needed when evaluating patients who complain of back pain.

Keyword

Osteomyelitis; Transverse process; Lumbar spine

MeSH Terms

Chronic Disease
Humans
*Lumbar Vertebrae
Magnetic Resonance Imaging
Male
Middle Aged
Osteomyelitis/*diagnosis/therapy
Spinal Diseases/*diagnosis/therapy
Staphylococcal Infections/*diagnosis/therapy
Tomography, X-Ray Computed

Figure

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  Fig. 1 The plain radiograph shows a subtle osteolytic lesion with surrounding sclerosis of the right transverse process of L5 (arrow).

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  Fig. 2 (A) Axial T1-weighted magnetic resonance imaging (MRI) reveals an intermediate signal intensity lesion (white arrow). (B) Axial T2-weighted MRI reveals high signal intensity in the space-occupying lesion (black arrow), which was located behind the right paraspinal muscle, and intermediate signal intensity in the muscle (white arrow).

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  Fig. 3 Axial enhanced computed tomography (CT) reveals a space-occupying lesion that showed a rim enhancement pattern (white arrow) and swelling and signal change of the paraspinal muscle (arrow-head). CT also reveals a 2 × 1 cm sized osteolytic lesion (black arrow) located in the right transverse process of L5.

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  Fig. 4 The postoperative plain radiograph shows the complete resection of the right transverse process of L5 (arrow).

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  Fig. 5 Histologically, the dense lamellar bone spaces are infiltrated by chronic inflammatory cells (H&E, × 100).

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  Fig. 6 The high power microscopic study shows a mixture of inflammatory cells that are mainly lymphocytes in the lamellar bone spaces (H&E, × 400).

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