Abstract
Vertebral osteomyelitis or spondylodiscitis is 2-7% of osteomyelitis. Iatrogenic spondylodiscitis accounts for 1-11%. Common organism is Staphylococcus aureus and usually the mean time from onset of symptoms to diagnosis has been reported to range from 8 weeks to 3 months. Worsening back pain with reduced spinal ROM is sine qua non on iatrogenic spondylodiscitis. CRP and ESR are most important prognostic factors of treatment. In this report I present three cases one which started florid infections and its signs and symptoms much later than documented times after operation, one who developed post procedural discitis by an atypical bacteria without any definite cause of it to do it, one with indolent tunneling infection of the vertebral body after minimally invasive discectomy without any considerable alteration in clinical functioning but with alteration radiologically and biochemically.
Keywords: Iatrogenic spondylodiscitis; Staphylococcus aureus; CRP; ESR; late infection; atypical bacteria; tunneling infection.
References
- Dagirmanjian A, Schils J, McHenry M. MR Imaging of spinal infections. Magn Reson Imaging Clin N Am. 1999;7:525-38.
- Tyrrell PNM, Cassar-Pollucino VN, McCall IW. Spinal infection. Eur Radiol1999; 9:1066-77.
- Stabler A, Reiser MF. Imaging of spinal infection. Radiol Clin North Am.2001; 39:115-35.
- Tang HJ, Lin JH, Lui YC, Li CM.Spinal epidural abscess: experience with 46 patients and evaluation of prognostic factors.J Infect2002;45:76-81.
- Rohde V, Meyer B, Schaller C, Hassler WE. Spondylodiscitis after lumbar discectomy: incidence and a proposal for prophylaxis.Spine1998;23:615-20.
- Maslen DR, Jones SR, Crislip MA, et al.Spinal epidural abscess: optimizing patient care. Arch Intern Med1993; 153:1713-21.
- Rawlings CE III, Wilkins RH, Gallis HA, Goldner JL, Francis R. Postoperative intervertebral disc space infection. Neurosurgery.1983;13:371–376.
- Silber JS, Anderson G, Vaccaro AR, Anderson PA, Mc-Cormick P. Manage-ment of postprocedur aldiskitis. Spine J.2002;2:279–287.
- Meyer B, Schaller K, Rohde V, Hassler W. The C-reactiveprotein for detection of early infections after lumbar microdisc-ectomy. ActaNeurochir (Wein). 1995;136: 145–150.
- Beiner JM, Grauer J, Kwon BK, Vaccaro AR. Postoperative wound infections of the spine. Neurosurg Focus 2003;15:E14.
- Olsen MA, Mayfield J, Lauryssen C, et al. Risk factors for surgical site infection in spinal surgery. J Neurosurg 2003;98:149-55.
- Beiner JM, Grauer J, Kwon BK, Vaccaro AR. Postoperative wound infections of the spine. Neurosurg Focus 2003;15:E14.
- Valentini LG, Casali C, Chatenoud L, Chiaffarino F, Uberti-Foppa C, Broggi G. Surgical site infections after elective neurosurgery: a survey of 1747 patients. Neurosurgery 2008;62:88-95.
- Olsen MA, Nepple JJ, Riew KD, et al. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am 2008;90:62-9.
- Pappou IP, Papadopoulos EC, Sama AA, Girardi FP, Cammisa FP. Postoperative infections ininter body fusion for degenerative spinal disease. Clin Orthop Relat Res 2006;444:120-8.
- Friedman ND, Sexton DJ, Connelly SM, Kaye KS. Risk factors for surgical site infection Complicating laminectomy. Infect Control Hosp Epidemiol 2007; 28:1060-5.
- Kanayama M, Hashimoto T, Shigenobu K, Oha F, Togawa D. Effective prevention of surgical site infection using a Centers for Disease Control and Prevention guideline-based antimicrobial prophylaxis in lumbar spine surgery. J Neurosurg Spine 2007;6:327- 9.
- Fang A, Hu SS, Endres N, Bradford DS. Risk factors for infection after spinal surgery. Spine (Phila Pa 1976) 2005;30: 1460-5.
- Mirovsky Y, Floman Y, Smorgick Y, et al. Management of deep wound infection after posterior lumbar interbody fusion with cages. J Spinal Disord Tech 2007;20:127-31.
- Weinstein MA, McCabe JP, Cammisa FP Jr. Postoperative spinal wound infection: a review of 2,391 consecutive index proced-ures. J Spinal Disord 2000; 13:422-6.
- Picada R, Winter RB, Lonstein JE, et al. Postoperative deep wound infection in adults after posteriorlumbosacral spine fusion with instrumentation: incidence and management. J Spinal Disord 2000;13:42- 5.
- Gaynes RP, Culver DH, Horan TC, Edwards JR, Richards C, Tolson JS. Surgical site infection (SSI) rates in the United States, 1992-1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis 2001;33Suppl 2:S69-77.
- Fessler RG, O’Toole JE, Eichholz KM, Perez-Cruet MJ. The development of minimally invasive spine surgery. NeurosurgClin N Am 2006;17:401-9.
- Emel E, KaragozGuzey F, Guzey D, Seyithanoglu H, Sel B, Alatas I. Delayed infection 6 years after spinal instrumentation: a case report. Turk Neurosurg 2007; 17:116-20.
- Lee JS, Ahn DK, Chang BK, Lee JI. Treatment of surgical site infection in posterior lumbar interbody fusion. Asian Spine J 2015;9:841-8.
- Kulkarni A.G., Patel Ravish S., Dutta S.Does Minimally Invasive Spine Surgery Minimize Surgical Site Infections?Asian Spine J 2016;10(6):1000-1006.
- Barton E, Flanagan P, Hill S. Spinal infection caused by ESBL-producing Klebsiella pneumonia treated with Temoc-illin. J. Infect. 2008 Oct,57(4):347-9.
- Kangwanprasert M, Young RS. Case report: spinal epidural abscess from Klebsiella Hawaii Med J. 2005 Aug;64(8):216-7.
- O’Toole JE, Eichholz KM, Fessler RG. Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine 2009;11:471-6.
- Ee WW, Lau WL, Yeo W, Von Bing Y, Yue WM. Does minimally invasive surgery have a lower risk of surgical site infections compared with open spinal surgery? Clin Orthop Relat Res 2014;472:1718-24.
- Shousha M, Cirovic D, Boehm H. Infection rate after minimally invasive non instrumented spinal surgery based on 4350 procedures. Spine (Phila Pa 1976) 2015;40:201-5.
- Cheng JS, Park P, Le H, Reisner L, Chou D, Mummaneni PV. Short-term and long-term outcomes of minimally invasive and open transforaminal lumbar interbody fusions: is there a difference? Neurosurg Focus 2013;35:E6.
Corresponding Author
Dr Suhasish Roy
Spine Surgeon, Bellevue Clinic, Kolkata
DOI: https://dx.doi.org/10.18535/jmscr/v5i11.114
