New combination of IntraSPINE device and posterior lumbar interbody fusion for rare skipped-level lumbar disc herniation: a case report and literature review

Delayed Infection 34 Months After IntraSPINE® Dynamic Internal Insertion

Introduction

Postoperative surgical site infection remains one of the major complications after spinal surgery. IntraSPINE^® (intraspine) is a dynamic intralaminar device introduced by Cousin Biotech and is indicated for the surgical treatment of lumbar spine disorders. There are no reports on delayed surgical site infection (SSI) after lumbar surgery using this device.

Case Presentation

A 29-year-old male patient was admitted to our department with complaints of moderate pain and chronic subcutaneous abscess with purulent flow from his old surgical scar. Thirty-four months ago, he underwent a traditional open bilateral L4 laminotomy without discectomy and intraspine insertion for the treatment of L4-5 central lumbar spinal stenosis at another hospital. The patient was discharged 4 days after surgery without radiating pain, and the surgical wound was well healed. He gradually returned to his normal activity and work. However, he experienced moderate pain, redness and swelling of his old surgical scar approximately one month before coming to our hospital, but he did not receive any treatment. One month later, he had a mass with purulent discharge at the surgical scar site, and he visited our hospital on December 29th, 2020. Based on the physical examination and MRI findings, delayed -SSI was diagnosed. The patient underwent removal of the intraspine device, debridement and wound closure with closed drainage. The wound healed satisfactorily, and the patient had no complaints more than 2 years later.

Conclusion

A delayed surgical site infection following intraspine insertion may have occurred.

Application of the IntraSPINE® interlaminar device in patients with osteoporosis and spinal stenosis: two case reports

Osteoporosis is a rising concern in the aging population and should be considered before performing spinal surgery for older patients. Nonfusion surgery using interlaminar or interspinous devices is gradually gaining acceptance because adjacent segment disease seldom occurs postoperatively; however, other complications may occur. This report discusses the surgical outcomes of two women with osteoporosis treated by laminectomy and interlaminar device (IntraSPINE®) placement. Both patients had experienced low back pain for several years and had developed vertebral compression fractures. Several conservative treatments, including rehabilitation and local injections, were ineffective. Their bone mineral density levels were −3.0 and −2.8, indicating severe osteoporosis according to the definition established by the World Health Organization. They chose to undergo nonfusion surgery with IntraSPINE® interlaminar device placement. Their pain significantly decreased postoperatively, and their visual analog scale scores decreased from 8 to 2 and 3. Their extremity numbness and back pain resolved within 3 months. Both patients were satisfied with the surgical outcomes. No complications had occurred by 1 year postoperatively. These cases indicate that osteoporosis may not be an absolute contraindication for nonfusion spinal surgery. This report suggests a possible alternative surgical treatment for patients with osteoporosis that is refractory to conservative treatments.