Case report: single-position PTP L2 corpectomy in a high-risk elderly patient

Spondylodiscitis complicated by bilateral psoas abscesses and spinal instability poses a significant management challenge, particularly in elderly patients with severe comorbidities. Conventional anterior or staged approaches may increase operative risk due to prolonged anesthesia and intraoperative repositioning. We report the case of a 72-year-old man with diabetes mellitus, hypertension, ischemic heart disease, and dilated cardiomyopathy (ejection fraction 20–25%) who presented with L2 spondylodiscitis, epidural abscess, and bilateral psoas abscesses following previous polytrauma. Despite his critical cardiac status, he underwent a single-position prone lateral transpsoas (PTP) L2 corpectomy with posterior thoracolumbar fixation and decompression after multidisciplinary optimization. The procedure was completed successfully with moderate blood loss and stable neuromonitoring signals. Postoperatively, the patient was extubated on day two, ambulated with support by day three, and demonstrated marked neurological and clinical improvement. Imaging confirmed adequate decompression and stable instrumentation. He was discharged on oral antibiotics after 14 days of rehabilitation. This case demonstrates the feasibility and safety of single-position PTP corpectomy in managing complex infectious spinal pathology in high-risk patients. The approach allows efficient circumferential decompression and stabilization while minimizing anesthetic and physiological stress. To the best of our knowledge, this represents the first successful PTP corpectomy performed in Saudi Arabia, emphasizing its potential role in advanced spinal reconstruction in similar high-risk cases.