Multi-stage surgery for a multiple-level spondylodiscitis caused by multidrug-resistant Mycobacterium avium complex

The objective of this article is to report a rare case of atypical mycobacterial spinal spondylodiscitis with multiple-level involvement and the successful treatment by multi-stage surgical intervention. Reports on the surgical management of atypical mycobacterial spondylodiscitis are lacking. A 71-year-old woman with a confirmed diagnosis of multiple-level spondylodiscitis of L2-L3 and L5-S1 caused by Mycobacterium avium complex (MAC). The patient underwent a two-stage surgical treatment (first: posterior instrumentation; second: anterior debridement with anterior lumbar interbody fusion). At 1 year after surgery, the patient suffered a proximal junctional failure secondary to a vertebral fracture that was solved with a proximal extension of the fusion using a percutaneous technique. The patient was successfully discharged with good pain control, satisfactory correction, no neurologic complications and an overall satisfactory outcome. A rare case of antibiotic-resistant multi-level spondylodiscitis due to MAC was treated successfully with multi-stage surgical treatment. Surgery in this patient group remains challenging due to the technical complexities and the difficulty of choosing the instrumentation levels.