{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T13:19:36Z","timestamp":1783603176441,"version":"3.55.0"},"reference-count":0,"publisher":"Indian Orthopaedic Research Group","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Jocr"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:p>Introduction: Lumbar canal stenosis is a common cause of low back pain occurring in the elderly population. It is treated with posterior decompression with or without fusion surgery. However, decompression can lead to iatrogenic instability in some cases and, if suspected, must be assessed intraoperatively and treated with instrumented fusion. If not addressed, it can lead to progressive degeneration and instability.\n\nCase Report: A 58-year-old male presented with severe low back pain and functional limitation 2 years after undergoing an L4 wide laminectomy for lumbar canal stenosis. While initial post-operative recovery was favourable, the patient developed progressive pain and immobility within 2 months post-surgery, ultimately becoming bedridden. Clinical examination revealed localised lumbosacral tenderness with a Visual Analogue Scale (VAS) score of 7\/10 and no neurological deficits. Laboratory investigations were unremarkable, ruling out infection. Radiological evaluation demonstrated severe osteoporosis, significant angular instability at L4-L5, and intra-discal degeneration, consistent with iatrogenic post-operative spinal instability. Given the patient\u2019s compromised bone quality, a surgical plan was devised involving posterior fixation spanning two levels above and below the instability, using pedicle screws and a bone graft mixture without a cage to minimise the risk of implant failure. Intraoperatively, clear discal fluid was aspirated for culture and tuberculosis testing, both of which returned negative. Postoperatively, the patient was placed on strict bed rest. At 1-month follow-up, substantial clinical improvement was noted with reduced pain (VAS 4\/10), improved mobility, and radiological evidence of stable instrumentation and early fusion.\n\nConclusion: This case report highlights the importance of recognising progressive postoperative instability as a potential delayed complication of lumbar laminectomy, particularly in osteoporotic patients, which should be addressed with a management strategy tailored to bone quality and biomechanical demands. Posterior instrumentation with interbody fusion using bone graft and bone graft substitutes has shown accelerated fusion results.\n\nKeywords: Lumbar laminectomy, post-operative instability, iatrogenic spinal instability, osteoporosis, lumbar fixation, bone graft substitute, pedicle screw instrumentation, intra-discal fluid, aseptic disk degeneration, spinal fusion, lumbar spine surgery complications, delayed spinal instability.<\/jats:p>","DOI":"10.13107\/jocr.2026.v16.i07.7662","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T12:56:13Z","timestamp":1783601773000},"page":"273-279","source":"Crossref","is-referenced-by-count":0,"title":["Aseptic Discitis with Instability after Posterior Spine Surgery"],"prefix":"10.13107","volume":"16","author":[{"given":"Parimal","family":"Vairagade","sequence":"first","affiliation":[{"name":"[1] Department of Orthopaedic Surgery, Apulki Vairagade Hospital, Nagpur, Maharashtra, India [2] Department of Orthopaedic Surgery, Government Medical College and Hospital Hanuman, Nagpur, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akhilesh","family":"Khobragade","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, MAX Super Speciality Hospital, Nagpur, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Faizan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, MAX Super Speciality Hospital, Nagpur, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paresh","family":"Bang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, MAX Super Speciality Hospital, Nagpur, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aishwarya","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubham","family":"Rajput","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5271","published-online":{"date-parts":[[2026]]},"container-title":["Journal of Orthopaedic Case Reports"],"original-title":[],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T12:56:14Z","timestamp":1783601774000},"score":1,"resource":{"primary":{"URL":"https:\/\/jocr.co.in\/wp\/2026\/07\/aseptic-discitis-with-instability-after-posterior-spine-surgery\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":0,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026]]},"published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.13107\/jocr.2026.v16.i07.7662","relation":{},"ISSN":["2321-3817"],"issn-type":[{"value":"2321-3817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]}}}