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Nguyen NQ, Phan TH. Delayed Infection 34 Months After IntraSPINE® Dynamic Internal Insertion. Int Med Case Rep J 2022; 15:479-483. [PMID: 36105875 PMCID: PMC9464639 DOI: 10.2147/imcrj.s376437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Ngoc Quyen Nguyen
- Department of Outpatient Clinic, 108 Military Central Hospital, Hanoi City, Vietnam
- Correspondence: Ngoc Quyen Nguyen, Department of Outpatient Clinic, 108 Military Central Hospital, No. 1, Tran Hung Dao Street, Ha Ba Trung District, Hanoi City, 113000, Vietnam, Tel +84-989052288, Email
| | - Trong Hau Phan
- Department of Spinal Surgery, 108 Military Central Hospital, Hanoi City, Vietnam
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Chen YC, Zhang L, Li EN, Ding LX, Zhang GA, Hou Y, Yuan W. Late deep cervical infection after anterior cervical discectomy and fusion: a case report and literature review. BMC Musculoskelet Disord 2019; 20:437. [PMID: 31554516 PMCID: PMC6761726 DOI: 10.1186/s12891-019-2783-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1–1.6% of early and late postoperative infection have been reported although the rate of late infection is very low. Case presentation Here, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient’s deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame. Conclusions This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.
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Affiliation(s)
- Ying-Chun Chen
- Department of Spine Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Yangfangdian, Beijing, 100038, China.
| | - Lin Zhang
- Department of Spine Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Yangfangdian, Beijing, 100038, China
| | - Er-Nan Li
- Department of Spine Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Yangfangdian, Beijing, 100038, China
| | - Li-Xiang Ding
- Department of Spine Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Yangfangdian, Beijing, 100038, China
| | - Gen-Ai Zhang
- Department of Spine Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Yangfangdian, Beijing, 100038, China
| | - Yu Hou
- Department of Spine Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Yangfangdian, Beijing, 100038, China
| | - Wei Yuan
- Department of Spine Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Yangfangdian, Beijing, 100038, China
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Esophageal Perforation due to Anterior Cervical Spine Hardware Placement: Case Series. Int J Otolaryngol 2019; 2019:7682654. [PMID: 31341480 PMCID: PMC6614980 DOI: 10.1155/2019/7682654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/22/2019] [Indexed: 01/10/2023] Open
Abstract
Context. This case series discusses surgical management of esophageal perforations that occurred following cervical spine hardware placement. Purpose. (1) Determine presenting symptoms of esophageal perforation after anterior cervical spine hardware placement. (2) Discuss surgical management of these resulting esophageal perforation complications. Design/Setting. Case series of six patients at a tertiary-care, academic medical center. Patient Sample. Six patients with pharyngoesophageal perforations following anterior cervical spine surgery (ACSS). Outcome Measures. Date of ACSS, indication for ACSS, level of hardware, location of esophageal or pharyngeal injury, symptoms at presentation, surgical intervention, type of reconstruction flap, wound culture flora, and antibiotic choice. Methods. A retrospective review of patients with an esophageal or hypopharyngeal injury in the setting of prior ACSS managed by the otolaryngology service at a tertiary, academic center between January 2015 and January 2019. Results. Six patients who experienced pharyngoesophageal perforation following ACSS are included in this study. Range of presentation was two weeks to eight years following initial hardware placement. Five patients presented with an abscess and all had evidence of perforation on initial CT or esophagram. All patients underwent repair with a sternocleidomastoid flap with two patients eventually requiring an additional pectoralis myofascial flap for a persistent esophageal leak. Five patients eventually attained ability to tolerate oral nutrition. An algorithm detailing surgical reconstructive management is proposed. Conclusions. Esophageal perforations in the setting of prior ACSS are challenging clinical problems faced by otolaryngologists. Consideration should be given to early drainage of abscesses and spine surgery evaluation. Spinal hardware removal is recommended whenever possible. Utilization of a pedicled muscle flap reinforces primary closure and allows coverage of the vertebral bony defect. Nutrition, thyroid repletion, and culture-directed IV antibiotics are necessary to optimize esophageal perforation repair.
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Mostofi K, Moghaddam BG, Peyravi M, Khouzani RK. Preliminary results of anterior cervical arthroplasty by porous alumina ceramic cage for cervical disc herniation surgery. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2019; 9:223-226. [PMID: 30787587 PMCID: PMC6364365 DOI: 10.4103/jcvjs.jcvjs_95_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective Anterior cervical arthroplasty (ACA) is the gold standard surgery in severe or unresponsive cases of cervical disc herniation, uncarthrosis, and foraminal stenosis. The aim of this study is to establish the impact and outcome evaluations of managing the patients operated for cervical arthroplasty by the intersomatic porous alumina ceramic cervical cages (PACC). The authors describe their experience in the area to allow the comparison of effectiveness of ceramic cages versus other interbody fusion cages. Materials and Methods Between April 2015 and September 2018, we operated 118 for ACA by using PACC. Among them, 52 were female and 66 were male, with an average age of 46.78 years. Results The mean symptoms duration was 14.1 months. The most frequent level of the disorder was C5-C6 followed by C6-C7 level. Mean follow-up was 3.3 years. The Neck Disability Index (NDI) and the visual analog scale (VAS) were used to evaluate the patients status. No significant differences were observed between our results and literature data regarding operative time, duration of hospitalization, and NDI; however, we observed a shorter period and higher rate of bony fusion. Conclusion The results from the present study corroborate that implementing of PACC is a good alternative treatment for the patient operated by ACA for cervical disc herniation or foraminal cervical stenosis.
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Affiliation(s)
- Keyvan Mostofi
- Department of Neurosurgery, Center Clinical, Chirurgie de Rachis, Soyaux, France
| | | | - Morad Peyravi
- Department of Neurosurgery, Werner Forssmann Hospital, Academic Hospital of Charité-Universitätsmedizin Berlin, Rudolf-Breitscheid, Eberswalde, Germany
| | - Reza Karimi Khouzani
- Department of Orthopedics, Rottal-Inn-Kliniken GmbH, Eggenfelden, Bayern, Germany
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Rosselló A, Sanmillán JL, López-Obarrio L, Pelegrín I, Gabarrós A, Godino O. Delayed surgical site infection 2 years after cervical disk arthroplasty. Case report and literature review. Neurocirugia (Astur) 2018; 30:81-86. [PMID: 29627290 DOI: 10.1016/j.neucir.2018.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/02/2018] [Accepted: 02/15/2018] [Indexed: 10/17/2022]
Abstract
Anterior cervical discectomy has a low non-mechanical complication rate. In our literature review, we found 7 cases of delayed surgical site infection. We report a case of cervical prevertebral abscess due to Propionibacterium acnes 2 years after discectomy and arthroplasty, with a beta-2-transferrin false positive test as a complementary highlighted finding. We discuss the diagnosis and etiology of this rare delayed infectious complication.
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Affiliation(s)
- Aleix Rosselló
- Neurosurgery Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Jose Luis Sanmillán
- Neurosurgery Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Luis López-Obarrio
- Neurosurgery Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Iván Pelegrín
- Infectious Diseases Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Andreu Gabarrós
- Neurosurgery Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oscar Godino
- Neurosurgery Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Cancienne JM, Werner BC, Hassanzadeh H, Singla A, Shen FH, Shimer AL. The Association of Perioperative Glycemic Control with Deep Postoperative Infection After Anterior Cervical Discectomy and Fusion in Patients with Diabetes. World Neurosurg 2017; 102:13-17. [DOI: 10.1016/j.wneu.2017.02.118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/25/2017] [Indexed: 10/20/2022]
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Jin SW, Kim SH, Choi JI, Ha SK, Lim DJ. Late infection from anterior cervical discectomy and fusion after twenty years. KOREAN JOURNAL OF SPINE 2014; 11:22-4. [PMID: 24891869 PMCID: PMC4040633 DOI: 10.14245/kjs.2014.11.1.22] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 02/12/2014] [Accepted: 02/14/2014] [Indexed: 11/23/2022]
Abstract
Anterior cervical discectomy and fusion (ACDF) has been performed for degenerative and traumatic cervical diseases to improve pain and neurologic symptoms including sensory change and motor weakness. Infection, however, is a rare complication of ACDF, and late infection is even much rarer. We present a case of late Infection from ACDF C4-5 using Biocompatible Osteoconductive Polymer (BOP) after twenty years in the absence of an esophageal perforation, Zenker's diverticulum, or recent surgery or bacteremia. Late infection from ACDF after 20 years is extremely rare in the literature. However, possibility of such a late complication should be appreciated during the follow-up period and surgical resection will be required for proper treatment.
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Affiliation(s)
- Sung-Won Jin
- Department of Neurosurgery, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Se-Hoon Kim
- Department of Neurosurgery, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jong-Il Choi
- Department of Neurosurgery, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sung-Kon Ha
- Department of Neurosurgery, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Dong-Jun Lim
- Department of Neurosurgery, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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Kasliwal MK, Tan LA, Traynelis VC. Infection with spinal instrumentation: Review of pathogenesis, diagnosis, prevention, and management. Surg Neurol Int 2013; 4:S392-403. [PMID: 24340238 PMCID: PMC3841941 DOI: 10.4103/2152-7806.120783] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 06/06/2013] [Indexed: 12/12/2022] Open
Abstract
Background: Instrumentation has become an integral component in the management of various spinal pathologies. The rate of infection varies from 2% to 20% of all instrumented spinal procedures. Every occurrence produces patient morbidity, which may adversely affect long-term outcome and increases health care costs. Methods: A comprehensive review of the literature from 1990 to 2012 was performed utilizing PubMed and several key words: Infection, spine, instrumentation, implant, management, and biofilms. Articles that provided a current review of the pathogenesis, diagnosis, prevention, and management of instrumented spinal infections over the years were reviewed. Results: There are multiple risk factors for postoperative spinal infections. Infections in the setting of instrumentation are more difficult to diagnose and treat due to biofilm. Infections may be early or delayed. C Reactive Protein (CRP) and Magnetic Resonance Imaging (MRI) are important diagnostic tools. Optimal results are obtained with surgical debridement followed by parenteral antibiotics. Removal or replacement of hardware should be considered in delayed infections. Conclusions: An improved understanding of the role of biofilm and the development of newer spinal implants has provided insight in the pathogenesis and management of infected spinal implants. This literature review highlights the mechanism, pathogenesis, prevention, and management of infection after spinal instrumentation. It is important to accurately identify and treat postoperative spinal infections. The treatment is often multimodal and prolonged.
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Affiliation(s)
- Manish K Kasliwal
- Department of Neurosurgery, RUSH University Medical Center Chicago, IL, USA
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Chidambaran V, Gentry C, Ajuba-Iwuji C, Sponsellar PD, Ain M, Lin E, Zhang X, Klaus SA, Njoku DB. A retrospective identification of gastroesophageal reflux disease as a new risk factor for surgical site infection in cerebral palsy patients after spine surgery. Anesth Analg 2013; 117:162-8. [PMID: 23687234 DOI: 10.1213/ane.0b013e318290c542] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Neuromuscular scoliosis is a known risk factor for surgical site infection (SSI) after spinal fusion, with reported infection rates as high as 11.2%. Although risk factors such as antibiotic timing have been previously addressed, our objective was to identify intrinsic risk factors for SSI in cerebral palsy (CP) patients with neuromuscular scoliosis. We hypothesized that CP patients who develop SSI after spine fusion would have a risk profile similar to those who develop nosocomial infection. METHODS We retrospectively analyzed records from patients with CP who developed infections after spinal fusion from January 1998 until July 2008, who were identified by our Infection Control Officer using National Nosocomial Infection Surveillance System criteria (N = 34). Demographically and procedurally matched controls without infection were identified from our spine database (N = 37). We compared these groups for gastroesophageal reflux disease (GERD), use of gastric acid inhibitors, presence of preoperative decubitus ulcer, previous infection, and postoperative ventilation. Multivariable logistic regression was then performed to assess the relative contributions of the predictors to "deep infection" and "any infection." RESULTS Of 30 evaluable infected patients, 70% had incisional SSI. Although many of the infections were polymicrobial, the most common pathogens identified were Gram-negative bacilli. Many significant predictors were identified by univariable logistic regression for any infection and deep infection. Multivariable logistic regression found a significant effect only for GERD (odds ratio, 6.4; 95% confidence interval, 1.9-21.3; P = 0.002) for any infection, whereas the effect of therapy with gastric acid inhibitors did not reach statistical significance (odds ratio, 6.1 [95% confidence interval, 0.84-44.6]; P = 0.07). No significant interaction between the 2 factors was detected. Among our controls and infected patients altogether, 46.3% had GERD. CONCLUSIONS We show that GERD increases the risk for infection in CP patients after spine fusion. Prospective multicenter studies are necessary to further validate the predictive value of this risk factor.
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Affiliation(s)
- Vidya Chidambaran
- Department of Anesthesiology and Critical Care Medicine, the Charlotte R. Bloomberg Children's Center, Johns Hopkins University, 800 Orleans St., Room 6349D, Baltimore, MD 21287, USA
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Korovessis P, Repantis T, Vitsas V, Vardakastanis K. Cervical spondylodiscitis associated with oesophageal perforation: a rare complication after anterior cervical fusion. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 23 Suppl 2:S159-63. [DOI: 10.1007/s00590-012-1092-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
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Infections associated with spinal implants. INTERNATIONAL ORTHOPAEDICS 2012; 36:451-6. [PMID: 22228378 DOI: 10.1007/s00264-011-1408-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 10/27/2011] [Indexed: 12/19/2022]
Abstract
Spinal infections represent a difficult challenge to treating clinicians. Infections in the presence of implants are even more so. In this review the literature appears to reflect a change of practice in which the aim is to retain implants if possible. The newer spinal procedures such as disc replacements pose different problems largely due to the more difficult access. The situation in the spine is more difficult than in general orthopaedics when dealing with infection due to the requirement for stability and to protect neurological function. The main thrust of management, therefore, is early diagnosis and a high index of suspicion followed by adequate if not radical management in a multidisciplinary setting. In the event prevention is better than cure and therefore consideration of the various mechanisms to avoid infection must be taken. There are some 'novel' considerations for the avoidance of infection alongside the tried and tested techniques. There are also new procedures for wound closure and the elimination of dead space.
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Berti AF, Santillan A, Berti AF. Bilateral psoas abscesses caused by methicillin-resistant Staphylococcus aureus (MRSA) after posterolateral fusion of the lumbar spine. J Clin Neurosci 2010; 17:1465-7. [PMID: 20692170 DOI: 10.1016/j.jocn.2010.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 04/04/2010] [Indexed: 11/30/2022]
Abstract
Psoas abscess following spine surgery is a rare condition that can be overlooked or delayed as a result of its vague clinical manifestations. Gone unchecked, it can lead to severe morbidity and even death. We present a 71-year-old female patient who developed bilateral psoas abscess immediately following L2 through S1 posterior instrumented fusion. The patient underwent CT-guided percutaneous drainage of the bilateral psoas abscess and blood cultures revealed methicillin-resistant Staphylococcus aureus (MRSA) sensitive to vancomycin. Following surgical re-exploration, debridement and removal of part of the instrumentation, the patient received antibiotic treatment for 12 weeks and at 1-year follow-up the patient continues asymptomatic.
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Affiliation(s)
- Aldo F Berti
- Department of Surgery, Section of Neurosurgery, University of Miami Hospital, Miami, Florida, USA
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Abstract
Biofilm is a complex aggregation of microorganisms. Biofilm, also called glycocalyx, functions within an extracellular slimy exopolysaccharide material. The morphology and pathogenesis of biofilm as it relates to Staphylococcus epidermidis in orthopaedic implant patients are presented.
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