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Lumbosacral Osteomyelitis and Discitis with Phlegmon Following Laparoscopic Sacral Colpopexy
Amanda V Jenson M D1, Robert Scranton1, Danielle D Antosh2
1Department of Neurosurgery, Houston Methodist Neurological Institute.
Abstract:
Lumbosacral osteomyelitis and discitis are usually a result of hematogenous spread; rarely it can result from direct inoculation during a surgical procedure. Bacteria may also track along implanted devices to a different location. This is a rare complication seen from pelvic organ prolapse surgery with sacral colpopexy. A 67-year-old female developed increasing lower back pain four months following a laparoscopic sacral colpopexy. Imaging revealed lumbar 5-sacral 1 (L5-S1) osteomyelitis and discitis with associated phlegmon confirmed by percutaneous biopsy and culture. The patient was treated conservatively with antibiotics, but required laparoscopic removal of the pelvic and vaginal mesh followed by twelve weeks of intravenous antibiotics. The patient has experienced clinical improvement of her back pain. This is an uncommon complication of sacral colpopexy, but physicians must be vigilant and manage aggressively to avoid more serious complications and permanent deficit.
Insights
A rare complication of sacral colpopexy surgery is infection of the lumbar spine (osteomyelitis and discitis). Prompt diagnosis and aggressive treatment, including mesh removal and antibiotics, are crucial for patient recovery.
Area of Science:
- Infectious Disease
- Spinal Surgery
- Gynecologic Surgery
Background:
- Lumbosacral osteomyelitis and discitis typically arise from hematogenous spread.
- Direct inoculation during surgery or tracking along implanted devices are rare causes.
- Pelvic organ prolapse surgery, specifically sacral colpopexy, can present unique infectious complications.
Observation:
- A 67-year-old female presented with worsening lower back pain four months post-laparoscopic sacral colpopexy.
- Imaging demonstrated lumbar 5-sacral 1 (L5-S1) osteomyelitis and discitis with a phlegmon.
- Percutaneous biopsy and culture confirmed bacterial infection.
Findings:
- Conservative antibiotic treatment was initially insufficient.
- Surgical intervention involving laparoscopic removal of pelvic and vaginal mesh was necessary.
- A twelve-week course of intravenous antibiotics followed the surgical procedure.
Implications:
- This case highlights an uncommon but serious complication of sacral colpopexy.
- Vigilance in diagnosing and aggressively managing such infections is essential.
- Timely intervention can prevent severe complications and long-term neurological deficits.
