Postoperative pyoderma gangrenosum after spinal fusion with instrumentation: case report
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Published on: June 23, 2020
M Harrison Snyder1, Leonel Ampie1, Vernon J Forrester2
1Departments of1Neurological Surgery and.
Abstract:
Pyoderma gangrenosum (PG) is a rare inflammatory dermatosis that is most often associated with inflammatory bowel disease, but which can occur as a pathergic reaction around surgical incisions. The authors report the case of a patient who developed postoperative PG over the course of several months after undergoing extensive spinal instrumentation between the T4 and iliac levels. This is only the second such case occurring after spine surgery to be reported. The authors additionally review the literature to characterize treatment approaches and outcomes for this condition. The case highlights a potentially severe adverse effect of surgery that can be difficult to recognize and causes delays in effective treatment. It also demonstrates the importance of multidisciplinary collaboration in the effective care of patients.
Insights
Pyoderma gangrenosum (PG) is a rare inflammatory skin condition that can occur after surgery. This case highlights the importance of recognizing and managing this severe adverse effect following extensive spinal procedures.
Area of Science:
- Dermatology
- Surgical Complications
- Inflammatory Disorders
Background:
- Pyoderma gangrenosum (PG) is a rare, ulcerative inflammatory skin disease.
- It is frequently associated with inflammatory bowel disease (IBD).
- PG can manifest as a pathergic response to surgical trauma.
Observation:
- A patient developed postoperative PG months after extensive spinal instrumentation (T4 to iliac levels).
- This represents the second reported case of PG following spine surgery.
- The condition presented as a diagnostic challenge, delaying effective treatment.
Findings:
- The literature review identified various treatment approaches for postoperative PG.
- Outcomes for PG following spinal surgery are variable and require further characterization.
- Early recognition and multidisciplinary management are crucial for optimal patient care.
Implications:
- Postoperative PG is a severe, albeit rare, complication of spinal surgery.
- Increased awareness among surgeons and dermatologists is necessary for timely diagnosis.
- Collaborative, multidisciplinary care is essential for managing this challenging condition.
