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Postoperative lumbar spinal stenosis after intertransverse fusion with granules of hydroxyapatite: a case report

Gen Inoue1*, Seiji Ohtori2, Tomoyuki Ozawa3, Toshinori Ito2, Morihiro Higashi4, Kazuyo Yamauchi2, Sumihisa Orita2, Junichi Nakamura2, Tomoaki Toyone3, Masashi Takaso1 and Kazuhisa Takahashi2

Author Affiliations

1 Department of Orthopaedic Surgery, Kitasato University, School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

2 Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan

3 Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan

4 Department of Pathology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan

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Diagnostic Pathology 2012, 7:153  doi:10.1186/1746-1596-7-153

Published: 7 November 2012


In the present case of postoperative lumbar spinal stenosis after non-instrumented intertransverse fusion with granules of hydroxyapatite (HA), bone union was not completed and the patient felt the recurrence of his symptoms within two years. We performed re-decompression with fusion, and in hematoxylin and eosin staining of HA granulation harvested during revision surgery, fibrous tissue with hyaline degeneration surrounded the cavity where the HA had existed. Multinuclear giant cells and lymphocytes infiltrated some parts of the marginal layer of the cavity, and no obvious bony bridge had regenerated from autologous bone. No tartrate-resistant acid phosphate (TRAP) -positive osteoclasts could be seen in the new bone, suggesting that the activity of osteoclasts in the new bone decreased during the seven years after the primary surgery.

Virtual slides

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Nonunion; Lumbar spine; Intertransverse fusion; Hydroxyapatite