Surgical Interventions in Chronic Recurrent Multifocal Osteomyelitis Affecting the Spine: A Case Report with Literature Review.

Abstract

Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare, skeletal, autoinflammatory disorder that predominantly affects young females. In this case-based review, we present a girl with progressive CRMO affecting the spine and causing spinal cord compression that required two surgical interventions.

Case report: A 10-year-old girl was presented to the pediatric rheumatologist because of diffuse back pain radiating to her legs, a waddling gait, and sensitivity to palpation in the caudal cervical vertebral region for the past several months. During the extensive multidisciplinary evaluation, spine magnetic resonance imaging (MRI) revealed C7 vertebral body collapse requiring reconstructive surgery. The pathohistological findings of the vertebral body samples indicated chronic inflammation, whereas the microbiological analysis was negative. Because CRMO was suspected, indomethacin therapy was started with slow regression of initial symptoms and further regular controls by surgeon and pediatric rheumatologist. Six months after the first operation, without any symptoms, the patient underwent regular control X-ray of the cervical spine, which revealed C6 vertebral body collapse. Soon after the second reconstructive surgery, she presented with subacute thoracic pain due to Th7 vertebral collapse, as verified by repeated MRI. No other skeletal lesions were detected. Finally, the tumor necrosis factor inhibitor adalimumab was initiated, which resulted in the slow resolution of pain and the lack of new symptoms.

Conclusion: Spine involvement in CRMO can lead to serious deformities and even life-threatening fractures. Effective multidisciplinary cooperation involving experienced surgeons, radiologists, pathologists, and rheumatologists is crucial for accurate diagnosis and timely combined management of CRMO and possible complications.