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Postoperative meningitis after spinal surgery: a review of 21 cases from 20,178 patients

Tung-Yi Lin, Wen-Jer Chen, Ming-Kai Hsieh

  • 1Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University, No, 5, Fusing St,, Guishan Township, Taoyuan 333, Taiwan. niuchien@cgmh.org.tw.

BMC Infectious Diseases
|April 24, 2014
PubMed
Abstract

Insights

Postoperative meningitis following spinal surgery is rare but serious. Early recognition of fever, neck stiffness, and altered consciousness is key for good outcomes, with no long-term adverse effects noted.

Area of Science:

  • Neurosurgery
  • Infectious Diseases
  • Clinical Medicine

Background:

  • Postoperative bacterial meningitis is a rare complication of spinal surgery, often linked to intraoperative incidental durotomy.
  • A high index of suspicion is crucial for timely diagnosis due to potential morbidity and mortality.
  • Few studies have reported on this rare complication, necessitating further clinical insights.

Purpose of the Study:

  • To report the clinical features, laboratory findings, treatment, and prognosis of patients with post-spinal surgery meningitis.
  • To analyze the incidence and predictors of meningitis after lumbar spinal surgery.

Main Methods:

  • Retrospective review of 21 patients diagnosed with postoperative meningitis after lumbar spinal surgery (January 2001 - August 2011).
  • Data collected included demographics, surgical details, clinical manifestations, laboratory and cerebrospinal fluid studies.
  • Patients received at least two weeks of antibiotic treatment, with outcomes assessed after a minimum two-year follow-up.

Main Results:

  • The incidence of postoperative meningitis was 0.10% (21 out of 20,178 spinal operations).
  • The classic triad (fever, neck stiffness, consciousness disturbance) was present in all patients.
  • No mortality was observed, and meningitis did not adversely affect long-term spinal surgery outcomes.

Conclusions:

  • Postoperative meningitis is a rare but significant complication of spinal lumbar surgery.
  • Maintaining a high index of suspicion for the clinical triad is vital for early diagnosis.
  • Intraoperative incidental durotomy is a key predictor, and prompt diagnosis and treatment lead to favorable outcomes.

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