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Infected vertebroplasty: case report and review of literature
Hemender Singh Vats1, Fergus E McKiernan
1Department of General Internal Medicine, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, USA. vats.hemender@marshfieldclinic.org
Study Design:
Case report.
Objectives:
To describe a case of infected vertebroplasty and to demonstrate the importance of polymerase chain reaction (PCR) in the diagnosis of such infections.
Summary Of Background Data:
Infection of the vertebroplasty site is an uncommon complication of vertebroplasty. Only 4 cases have been reported in the literature so far, and an organism could be identified in only 2 of those cases. To our knowledge, the use of PCR to diagnose infection in these cases has not been reported before.
Methods:
Vertebroplasty, laminectomy, radiology, fluid aspiration, microbial culture, and 16S RNA PCR.
Results:
A 73-year-old diabetic woman underwent vertebroplasty for L2 and L3 vertebral compression fractures followed by L4-L5 laminectomy for spinal stenosis. Three months later, she had an L1 fracture that was augmented with vertebroplasty. Six months later, she presented with incapacitating low back pain. There was a fluid-filled cavity surrounding the polymethylmethacrylate in the L1 and L2 vertebral bodies. The fluid had 95,000 white blood cells with 96% neutrophils, grew nothing on culture, but had 100% homology with Streptococcus agalactiae on 16S ribosomal nucleic acid analysis.
Conclusions:
We report a case of infected vertebroplasty with atypical radiologic findings of vertebral infection. To our knowledge, this is the third reported case where an organism could be isolated for these infections and the first time PCR has been used to diagnose such an infection.
Insights
Polymerase chain reaction (PCR) aided in diagnosing a rare infected vertebroplasty case. This method identified Streptococcus agalactiae when traditional cultures failed, highlighting PCR
Area of Science:
- Spinal surgery
- Infectious disease diagnostics
- Molecular biology
Background:
- Vertebroplasty is a procedure to treat vertebral compression fractures.
- Infection is a rare but serious complication of vertebroplasty.
- Identifying the causative organism in infected vertebroplasty is challenging.
Observation:
- A 73-year-old diabetic woman developed low back pain six months after vertebroplasty.
- Radiology revealed a fluid-filled cavity around the polymethylmethacrylate.
- Fluid analysis showed high white blood cell count but negative microbial cultures.
Findings:
- 16S ribosomal RNA (rRNA) polymerase chain reaction (PCR) identified Streptococcus agalactiae in the fluid.
- This is the first reported use of PCR for diagnosing infected vertebroplasty.
- The organism was identified despite negative traditional cultures.
Implications:
- PCR is a valuable tool for diagnosing uncommon infections after vertebroplasty.
- Early and accurate diagnosis can lead to timely and appropriate treatment.
- This case highlights the utility of molecular diagnostics in challenging infectious cases.
