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Retroperitoneal pseudomeningocele complicated by meningitis following a lumbar burst fracture. A case report
J G Nairus1, J D Richman, R A Douglas
1University of Cincinnati College of Medicine, Ohio, USA.
Study Design:
This case report demonstrates an unusual complication after anterior decompression and fusion of a lumbar burst fracture.
Objectives:
The treatment of this patient involved placement of a computed tomography-guided percutaneous drain and intravenous antibiotics to treat an infected retroperitoneal pseudomeningocele.
Summary Of Background Data:
A case of an anterior retroperitoneal pseudomeningocele complicated by meningitis is presented. This pseudomeningocele occurred in a patient after an L3 burst fracture associated with a dural laceration.
Methods:
The patient was admitted to the authors' trauma unit after a motor vehicle accident with an acute L3 fracture associated with incomplete paraplegia. He underwent an urgent anterior corpectomy, strut grafting, and instrumentation. At surgery, he was noted to have a large anterior dural laceration. After surgery, a large retroperitoneal pseudomeningocele developed that became infected with Staphylococcus epidermidis.
Results:
After placement of a computed tomography-guided percutaneous drain and intravenous antibiotics, the pseudomeningocele resolved. His anterior fusion healed uneventfully and his neurologic deficit improved dramatically.
Conclusions:
A case of an anterior retroperitoneal pseudomeningocele complicated by meningitis is presented. This pseudomeningocele occurred in a patient after an L3 burst fracture associated with a dural laceration. The patient was treated successfully with computed tomography-guided percutaneous drain placement and intravenous antibiotics. He made an excellent functional recovery after a severe neurologic injury.
Insights
An infected retroperitoneal pseudomeningocele after lumbar burst fracture surgery was successfully treated with a CT-guided drain and antibiotics. This approach led to pseudomeningocele resolution and improved neurologic function.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Infectious Disease
Background:
- Anterior retroperitoneal pseudomeningocele is a rare complication following lumbar burst fractures and dural lacerations.
- This case involves a patient with an L3 burst fracture and incomplete paraplegia, treated with anterior decompression and fusion.
Observation:
- A large anterior dural laceration was noted during surgery for the lumbar burst fracture.
- Postoperatively, the patient developed an infected retroperitoneal pseudomeningocele caused by Staphylococcus epidermidis.
Findings:
- Computed tomography-guided percutaneous drain placement and intravenous antibiotics effectively resolved the infected pseudomeningocele.
- The anterior spinal fusion healed successfully, and the patient experienced significant improvement in his neurologic deficit.
Implications:
- This case highlights a successful management strategy for infected retroperitoneal pseudomoceles after spinal surgery.
- Prompt diagnosis and treatment, including percutaneous drainage and antibiotics, can lead to excellent functional recovery even after severe neurologic injury.