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Delayed Surgical Site Infection with Progressive Myelopathy Following Hydroxyapatite Spacer Dislodgement in
Pranavakumar Palaninathan1, Karthik Ramachandran, Niventhiran Kuppusamy
1Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd, Coimbatore, India.
Case:
A 73-year-old gentleman presented with clinical features of progressive cervical myelopathy for a month. He underwent C3-C6 double-door laminoplasty with a hydroxyapatite (HA) spacer 16 years ago. Magnetic resonance imaging scan revealed a delayed infection at the laminoplasty site, along with dislodgement of the HA spacers. He underwent thorough surgical debridement with removal of the spacers, followed by an appropriate antibiotic regimen based on culture sensitivity pattern.
Conclusion:
Delayed infection following HA spacer dislodgement is a rare event, causing progressive myelopathy in laminoplasty. However, it can be effectively treated by timely diagnosis followed by thorough debridement, complete removal of spacers, and appropriate antibiotic management.
Insights
Delayed infection and hydroxyapatite (HA) spacer dislodgement after laminoplasty can cause cervical myelopathy. Prompt surgical debridement, spacer removal, and antibiotics effectively treat this rare complication.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Infectious Diseases
Background:
- Cervical myelopathy can result from delayed complications following spinal surgery.
- Laminoplasty, a procedure to decompress the cervical spine, may utilize implants like hydroxyapatite (HA) spacers.
- Delayed infections and implant dislodgement are potential, though uncommon, risks associated with spinal fusion materials.
Purpose of the Study:
- To report a rare case of delayed infection and hydroxyapatite (HA) spacer dislodgement after cervical laminoplasty.
- To highlight the clinical presentation and diagnostic findings of this complication.
- To emphasize the effective management strategy for this specific post-operative issue.
Main Methods:
- A 73-year-old male patient with progressive cervical myelopathy was evaluated.
- Magnetic resonance imaging (MRI) identified a delayed infection and dislodged HA spacers at the C3-C6 laminoplasty site.
- Surgical debridement, removal of HA spacers, and targeted antibiotic therapy were performed.
Main Results:
- The patient presented with symptoms of cervical myelopathy 16 years after C3-C6 double-door laminoplasty with HA spacers.
- Diagnostic imaging confirmed a delayed infection and dislodgement of the HA spacers.
- Post-operative treatment with surgical debridement and antibiotics led to resolution of symptoms.
Conclusions:
- Delayed infection and HA spacer dislodgement following laminoplasty is a rare cause of progressive cervical myelopathy.
- Timely diagnosis and comprehensive treatment, including surgical debridement, complete spacer removal, and appropriate antibiotics, are crucial for effective management.
