title: Is spinal instrumentation a risk factor for late-onset infection in cases of distant infection or surgery? Case report.
abstract: As a cause of revision spinal surgery, spinal epidural abscess after instrumentation-assisted fusion is rare in neurosurgical practice. Postoperative infections are frequently seen in the time period soon after surgery. The authors report on the case of a 45-year-old woman who had undergone posterior instrumentation-augmented fusion for L4-5 degenerative spondylolisthesis. Ten months after the operation she presented to the neurosurgery clinic with complaints of severe low-back pain and radicular right lower-extremity pain. She had undergone laparoscopic surgery for acute cholecystitis 1 month prior to readmission. Radiological study revealed a spinal epidural abscess in communication with a right psoas abscess at L4-5. The abscess was drained percutaneously with the aid of C-arm fluoroscopic guidance, and a 6-week course of parenteral antibiotic therapy was administered. Retrograde lymphatic bacterial translocation, hematopoietic spread, and the suitable characteristics in the host may facilitate the development of infection around the implant. Thus, distant surgery and infection may be a risk factor in cases in which spinal instrumentation is placed. In such cases a prolonged antibiotic therapy for distant infection after surgery is recommended.
authors.affiliation: Department of Neurosurgery, School Of Medicine, Dokuz Eylül University, Izmir, Turkey. snaderi@deu.edu.tr
authors.forename: Sait
authors.initials: S
authors.lastname: Naderi
authors.forename: Feridun
authors.initials: F
authors.lastname: Acar
authors.forename: Tansu
authors.initials: T
authors.lastname: Mertol
mesh_terms: D019072:Antibiotic Prophylaxis; D001416:Back Pain / Q000209:etiology; D016470:Bacteremia / Q000209:etiology; D001422:Bacterial Adhesion; D018441:Biofilms; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000150:complications* / Q000601:surgery; D003131:Combined Modality Therapy; D016207:Cytokines / Q000378:metabolism; D004322:Drainage; D020802:Epidural Abscess / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D004866:Equipment Contamination; D005260:Female; D005471:Fluoroscopy; D005549:Foreign-Body Reaction / Q000209:etiology; D006801:Humans; D007249:Inflammation; D016268:Internal Fixators / Q000009:adverse effects*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D016659:Psoas Abscess / Q000209:etiology* / Q000601:surgery; D015641:Radiography, Interventional; D012307:Risk Factors; D012585:Sciatica / Q000209:etiology; D013168:Spondylolisthesis / Q000601:surgery*; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D016207:Cytokines; D014640:Vancomycin