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Published on: June 23, 2020
Is spinal instrumentation a risk factor for late-onset infection in cases of distant infection or surgery? Case
Sait Naderi1, Feridun Acar, Tansu Mertol
1Department of Neurosurgery, School Of Medicine, Dokuz Eylül University, Izmir, Turkey. snaderi@deu.edu.tr
Abstract:
As a cause of revision spinal surgery, spinal epidural abscess after instrumentation-assisted fusion is rare in neurosurgical practice. Postoperative infections are frequently seen in the time period soon after surgery. The authors report on the case of a 45-year-old woman who had undergone posterior instrumentation-augmented fusion for L4-5 degenerative spondylolisthesis. Ten months after the operation she presented to the neurosurgery clinic with complaints of severe low-back pain and radicular right lower-extremity pain. She had undergone laparoscopic surgery for acute cholecystitis 1 month prior to readmission. Radiological study revealed a spinal epidural abscess in communication with a right psoas abscess at L4-5. The abscess was drained percutaneously with the aid of C-arm fluoroscopic guidance, and a 6-week course of parenteral antibiotic therapy was administered. Retrograde lymphatic bacterial translocation, hematopoietic spread, and the suitable characteristics in the host may facilitate the development of infection around the implant. Thus, distant surgery and infection may be a risk factor in cases in which spinal instrumentation is placed. In such cases a prolonged antibiotic therapy for distant infection after surgery is recommended.
Insights
Spinal epidural abscess is a rare complication following spinal fusion surgery. A distant infection, like cholecystitis, may increase the risk of developing this serious spinal complication.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Infectious Disease
Background:
- Spinal epidural abscess (SEA) is an uncommon but serious complication following spinal surgery, particularly with instrumentation.
- Postoperative infections typically manifest early, but late-onset SEAs can occur.
Observation:
- A 45-year-old woman presented with severe low-back and radicular leg pain 10 months after posterior instrumentation-augmented fusion for L4-5 degenerative spondylolisthesis.
- A recent laparoscopic cholecystectomy (gallbladder surgery) was noted one month prior to her current neurosurgical evaluation.
- Radiological imaging confirmed a spinal epidural abscess at L4-5 communicating with a right psoas abscess.
Findings:
- Percutaneous drainage of the abscesses was performed under C-arm fluoroscopic guidance.
- A six-week course of parenteral antibiotic therapy was initiated.
- The case highlights potential mechanisms for late-onset SEA, including retrograde lymphatic translocation, hematogenous spread, and host factors.
Implications:
- Distant infections and prior surgeries may represent a risk factor for developing implant-associated spinal infections.
- Prolonged antibiotic therapy is recommended for patients with distant infections after spinal instrumentation placement.
- This case underscores the importance of considering distant infectious sources in the differential diagnosis of late-onset spinal epidural abscesses.
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