1232 - Not Your Average Slinky: A Curious Case Report

Case Diagnosis: Chronic osteomyelitis-induced osteolysis of the vertebral column

Case Description: A 65-year-old male with a past medical history of long-standing T6 ASIA Impairment Scale (AIS) A spinal cord injury (SCI), spinal neuroarthropathy (SNA) and vertebral osteomyelitis three years prior presented to establish care at our SCI clinic. He reported progressive sharp back pain over the last several months and felt shorter than in the past. He mentioned that his back was bending more than before, and that it "felt like a slinky." On exam, when he extended his back, the contour was normal. When he flexed his back, a "V" shaped bony protrusion appeared in the midline of his back. Imaging from five years prior showed an intact bony spine. At the current presentation, lumbar X-ray and subsequent MRI revealed absent L5 and S1 vertebral body and posterior elements with no bony connection between the residual sacrum and lumbar spine.

Discussions: Unfortunately, the patient developed osteomyelitis at the beginning of the COVID-19 pandemic, and he did not have a follow-up clinical evaluation until three years later. Interestingly, the patient's SCI likely masked symptoms until significant deterioration had occurred. Despite experiencing autonomic dysreflexia when his catheter gets clogged, he did not experience similar symptoms related to this injury. Given the temporality of the patient's osteomyelitis and imaging findings, it is likely to have caused our patient's lumbar-sacral dissociation. Since the patient was largely asymptomatic, other than tolerable pain, and there was no radiological evidence of active osteomyelitis, further workup and surgery were deferred for the time being.



Conclusions: Patients with SCI are at increased risk for osteomyelitis, which can lead to osteolysis. Due to the physiology of SCI, complications of chronic osteomyelitis may be largely masked. Physiatrists should maintain a high suspicion for possible complications of osteomyelitis and perform thorough clinical evaluations post-infection.