title: Repeated meningitis as a delayed complication of scoliosis surgery.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To report a case of very delayed repeated meningitis after surgical treatment of scoliosis.
  
  
  BACKGROUND
  Delayed infection after spine surgery is a well-reported phenomenon, presenting usually with local wound symptoms and back pain. The occurrence of meningitis after spinal instrumentation is reported but not common. Delayed repeated episodes of meningitis after surgical treatment of scoliosis have never been reported.
  
  
  METHODS
  We report a case of a 44-year-old gentleman, submitted to surgical treatment of scoliosis years ago, who presented with repeated episodes of meningitis due to the formation of an abnormal communication between an infected cyst in the bone cavity where the rods were located and the intradural space in the lumbar spine. Computerized tomography and magnetic resonance imaging revealed the presence of a bone cyst with thickened layering, and surgical exploration revealed the communication between this cystic cavity and the intradural space. After surgical closure of the dural space and cleaning of the cyst, the patient responded well to antibiotic therapy and was free of new episodes of meningitis up to the last follow-up, 1 year after the surgical treatment. Clinical diagnosis of delayed postoperative infection in spine surgery may be difficult if no wound signs are present. Clinical symptoms vary and may include increased back pain, wound redness, swelling and drainage, elevated erythrocyte sedimentation rate and white blood count, fever, and malaise.
  
  
  CONCLUSIONS
  Delayed meningitis can be a late complication of spinal instrumentation for scoliosis. A high index of suspicion is necessary.
authors.affiliation: Division of Neurosurgery, Saint Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. leodante@gmail.com
authors.forename: Leodante B
authors.initials: LB
authors.lastname: da Costa
authors.forename: Henry
authors.initials: H
authors.lastname: Ahn
authors.forename: Walter
authors.initials: W
authors.lastname: Montanera
authors.forename: Howard
authors.initials: H
authors.lastname: Ginsberg
mesh_terms: D000328:Adult; D001858:Bone Nails / Q000009:adverse effects*; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012008:Recurrence; D012600:Scoliosis / Q000601:surgery*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016985:Streptococcus bovis; D013997:Time Factors