Ann Rehabil Med.  2013 Oct;37(5):725-729. 10.5535/arm.2013.37.5.725.

Thoracic Infectious Spondylitis After Surgical Treatments of Herniated Lumbar Intervertebral Disc

• Kim JH
• Kang JI
• Kim MJ
• Koh SE
• Lee J
• Lee IS
• Jung H

• KMID: 2266593
• DOI: http://doi.org/10.5535/arm.2013.37.5.725

Abstract

The postoperative infectious spondylitis has been reported to occur among every 1% to 12%. It is difficult to early diagnose in some cases. If the diagnosis is delayed, it can be a life-threatening condition. We report a 32-year-old male patient with postoperative infectious spondylitis. He had surgical treatments for traumatic intervertebral disc herniations in L3-4 and L4-5. Three weeks after surgery, he complained for fever and paraplegia. Cervicothoracic magnetic resonance imaging showed the collapsed T2 and T3 vertebral body with changes of bone marrow signal intensity. Moreover, it showed anterior and posterior epidural masses causing spinal cord compressions which suggested infectious spondylitis. After the use of antibiotics and surgical decompressions T2-T3, his general conditions were improved and muscle power of lower extremities began to be gradually restored. However, we could not identify the exact organisms that may be the cause of infectious spondylitis. It could be important that the infectious spondylitis, which is presented away from the primary operative level, should be observed in patients with fevers of unknown origin and paraplegia.

Keyword

Spondylitis; Intervertebral disc displacement; Spinal cord compression

MeSH Terms

Adult
Anti-Bacterial Agents
Bone Marrow
Decompression, Surgical
Fever
Humans
Intervertebral Disc Displacement
Intervertebral Disc*
Lower Extremity
Magnetic Resonance Imaging
Male
Muscles
Paraplegia
Spinal Cord Compression
Spondylitis*
Anti-Bacterial Agents

Figure

• 

  Fig. 1 Lumbosacral spine X-ray shows a surgical intervention of posterior instrumentation from L3 to L5 vertebrae: (A) lateral image, (B) anteroposterior image.

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  Fig. 2 (A) Sagittal T2-weighted magnetic resonance image of the cervicothoracic spine showing collapsed T2 and T3 vertebrae (arrow), anterior and posterior epidural mass formation, causing compressive myelopathy at T2 to T4 level. (B) Axial T2-weighted magnetic resonance image between T2 and T3 level.

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  Fig. 3 (A) Sagittal contrast-enhanced T1-weighted magnetic resonance image of the cervicothoracic spine showing collapsed T2 and T3 vertebrae (arrow) and enhanced anterior and posterior epidural mass formation, causing compressive myelopathy at T2 to T4 level. (B) Axial contrast-enhanced T1-weighted magnetic resonance image between T2 and T3 level.

Reference

1. An KC, Kim KY, Heo MJ, Kim JS. Monitoring for deep wound infection after thoracolumbar surgery significance of suction drainage tip culture for early detection of postoperative deep wound infection. J Korean Soc Spine Surg. 2006; 13:23–31.

2. Lee CS. Pyogenic infection of the spine. J Korean Soc Spine Surg. 1999; 6:247–255.

3. Ha KY, Wee D, Park SJ, Yeon G, Han SG. Latent multiple noncontiguous pyogenic spondylitis: a case report. J Korean Orthop Assoc. 1997; 32:517–522.

4. Lohr M, Reithmeier T, Ernestus RI, Ebel H, Klug N. Spinal epidural abscess: prognostic factors and comparison of different surgical treatment strategies. Acta Neurochir (Wien). 2005; 147:159–166. PMID: 15570436.

5. Gerometta A, Bittan F, Rodriguez Olaverri JC. Postoperative spondilodiscitis. Int Orthop. 2012; 36:433–438. PMID: 22307558.

6. Tyrrell PN, Cassar-Pullicino VN, McCall IW. Spinal infection. Eur Radiol. 1999; 9:1066–1077. PMID: 10415237.

7. Cheung WY, Luk KD. Pyogenic spondylitis. Int Orthop. 2012; 36:397–404. PMID: 22033610.

8. Modic MT, Feiglin DH, Piraino DW, Boumphrey F, Weinstein MA, Duchesneau PM, et al. Vertebral osteomyelitis: assessment using MR. Radiology. 1985; 157:157–166. PMID: 3875878.