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Diptheroids and associated infections as a cause of failed instrument stabilization procedures in the lumbar spine
L Schofferman1, J Zucherman, J Schofferman
1SpineCare Medical Group, Daly City, California.
Abstract:
Between February 1985 and October 1987, the authors identified seven patients with occult lumbar spine infections associated with the presence of spinal fixation hardware. Six of these infections were with organisms of low virulence; four of the seven patients had polymicrobial infections. All of the polymicrobial infections contained a Diptheroid as one of the isolates. Two of the seven patients studied had normal sedimentation rates. All had white blood cell counts less than 12,000 cells. Imaging studies were not helpful with the exception of one case with a positive gallium scan. The diagnoses were supported by clinical presentation, pathologic tissue changes, positive cultures, and response to therapy. Successful therapy was obtained by removal of hardware and treatment with antibiotics.
Insights
Occult lumbar spine infections linked to spinal fixation hardware are challenging to diagnose. Prompt hardware removal and antibiotic treatment are crucial for successful patient recovery.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Neurosurgery
Background:
- Occult infections of the lumbar spine present diagnostic challenges.
- Spinal fixation hardware is a potential nidus for infection.
- Low-virulence organisms and polymicrobial infections complicate diagnosis.
Purpose of the Study:
- To investigate the clinical characteristics of occult lumbar spine infections associated with spinal fixation hardware.
- To evaluate diagnostic methods and treatment outcomes for these infections.
Main Methods:
- Retrospective review of seven patients with occult lumbar spine infections and spinal fixation hardware.
- Analysis of clinical presentation, laboratory findings, imaging, and microbiological data.
- Evaluation of treatment strategies, including hardware removal and antibiotic therapy.
Main Results:
- Six of seven infections involved low-virulence organisms; four were polymicrobial.
- Diptheroids were common in polymicrobial infections.
- Elevated white blood cell counts were not consistently observed; sedimentation rates were normal in two patients.
- Radiological imaging was largely unhelpful, except for one positive gallium scan.
- Diagnosis was confirmed by clinical, pathological, and microbiological evidence.
Conclusions:
- Occult lumbar spine infections associated with spinal hardware require a high index of suspicion.
- Diagnosis relies on a combination of clinical, laboratory, and microbiological findings.
- Surgical removal of hardware combined with appropriate antibiotic therapy is the mainstay of successful treatment.