An anterior expandable titanium cage in Mycobacterium avium vertebral osteomyelitis

Mycobacterial infection is most commonly caused by Mycobacterium tuberculosis. M. avium and M. intracellulare are two other organisms within the Mycobacteria group often classified together as the mycobacterium avium-intracellulare complex (MAC). MAC is of low virulence and usually causes disease in immunocompromised patients such as those with the human immunodeficiency virus. Isolated vertebral osteomyelitis secondary to MAC infection is rare with only 18 previous reports, only one of which required surgical intervention. There is increasing evidence that vertebral body osteomyelitis with other pathogens can be treated with decompression, debridement and reconstruction with titanium vertebral body cages in the setting of active infection. We present a 70-year-old Caucasian male with a pathological fracture of T6 vertebral body and a kyphosis of 60° and MRI findings consistent with granulomatous osteomyelitis. Vertebrectomies of T5 and T6 were performed and an expandable titanium cage was inserted with supplementary lateral fixation using plate and screws. This is the first report of a single-stage decompression and fusion with a titanium vertebral body cage for active MAC vertebral osteomyelitis.