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Postoperative multisegmental lumbar discitis treated by staged ventrodorsoventral intervention
Yohan Robinson1, Marcus Reinke, Ralph Kayser
1Charité-Campus Benjamin Franklin, Department of Trauma and Orthopaedic Surgery, Spine Unit, Klinik für Unfall- und Wiederherstellungschirurgie, Berlin, Germany.
Background:
Postoperative spinal infections are relatively rare. They can become life-threatening.
Case Report:
A 56-year-old man developed multisegmental spinal infection with methicillin-resistant Staphylococcus aureus after discectomy at L3/4. A staged ventrodorsoventral intervention was needed for radical debridement and stabilization. After femoral head necrosis developed as a result of the infection, a Girdlestone hip was maintained until the joint was aseptic and a hip prosthesis could be implanted. Two years postoperatively, the patient remained free of infection recurrence.
Conclusion:
Radical debridement and a tightly controlled antibiotic regimen are necessary for the management of postoperative spinal infections. This should include staged interventions until recovery from infection is possible. Early intervention can prevent systemic sepsis caused by widespread bacterial dissemination.
Insights
Postoperative spinal infections, though rare, can be life-threatening. Prompt, radical debridement and a controlled antibiotic regimen, potentially involving staged interventions, are crucial for successful management and preventing sepsis.
Area of Science:
- Spinal surgery
- Infectious diseases
- Orthopedic surgery
Background:
- Postoperative spinal infections are infrequent but pose significant risks, potentially becoming life-threatening.
- Early recognition and intervention are critical to prevent severe complications.
Observation:
- A case of multisegmental spinal infection caused by methicillin-resistant Staphylococcus aureus (MRSA) following L3/4 discectomy is presented.
- The patient required a staged ventrodorsoventral surgical intervention for debridement and stabilization.
- Complications included femoral head necrosis, necessitating a Girdlestone hip procedure prior to definitive hip arthroplasty.
Findings:
- Successful management involved radical debridement and a comprehensive, staged surgical approach.
- A prolonged, tightly controlled antibiotic regimen was essential for eradicating the infection.
- The patient achieved infection-free status two years postoperatively.
Implications:
- This case underscores the necessity of aggressive surgical management and meticulous antibiotic stewardship in treating complex postoperative spinal infections.
- Staged interventions may be required for complete infection control and spinal stabilization.
- Timely and thorough treatment can prevent systemic sepsis and long-term morbidity.
