The patient  was operated by me 04-July-2011 for fixation of L1 with L3 after complete destruction of L2 due to osteomyelitis. The patient was operated at that time after massive antibiotic therapy for several weeks.

The patient is a Yemeni citizen and she was followed by telephone over the months and was kept in Dalacine-C 300 , which did not tolerate after 4-5 months and replaced with erythromycin until today, because the CRP and ESR became lower but still high.

The patient then came for follow up 24-April-2012 and she is still complaining of bilateral sciatica more the left, but she can walk without assistance.

On examination, the patient can walk be herself. SLRS was 50 degrees in the right and 45 degrees with pain in the left. The power of both lower limbs and sensation were preserved.

The patient was sent for MRI of the lumbar spine with contrast, CT-scan L1 down to S1 and LSS X-ray dynamic study. They were done 26-April-2012 showing slipping of the lower screws down about 5 mm in both sides, migrating outside the pedicular territory, thus irritating the roots at this level.

Exposure the construct and the connector. Using Zimmer instrumentation of Java Instinct  was incompatible with the screw drivers of Java 1 mentioned earlier, for what, it was necessary to drill out the nuts and the connector. Due to this mishap of production, it was necessary to remove all the screws and two Java Instinct Zimmer monoaxial 7.5x40 mm screws inserted at the same place of L1. Four polyaxial Java Instinct Zimmer screws 7.5x45 mm were inserted to the L3 and L4 bodies. The rods length was 110 mm both sides bended slightly to adopt the natural local curvature. 62 mm transverse connector was applied. All stages of surgery were performed under image-intensifier control.

Routine closure of the wound. Smooth postoperative recovery.

The patient had in the start osteomyelitis of L2 with complete destruction and she could not even set down, because the upper part of the lumbar spine was completely flail and had pockets of pus in the left psoas muscle. Surgery was mandatory, because the patient was in miserable condition.

Osteomyelitis and osteoporosis were the triggering factors for downward migration of the lower screws for about 5 mm both sides. Even the interbody part was inside the bone of L3, but the pedicular part slipped down out of the pedicles, irritating the running nearby roots.

Zimmer must respect their brands, so as to have such conflict, that using one brand is mission impossible to correct the other brand. At least they must warn the neurosurgeon to be ready to accomplish his task without falling into troubles.