title: Two recurrences of adjacent spondylodiscitis after initial surgical intervention with posterior stabilization, debridement, and reconstruction of the anterior column in a patient with spondylodiscitis: a case report.
abstract: METHODS
  Case report.
  
  
  BACKGROUND
  This report describes a patient who had 2 episodes of destructive spondylodiscitis occurring adjacent to levels at which surgery had previously been carried out due to an initial spondylodiscitis. A review of the literature did not reveal any equivalent cases. A comprehensive description of the management of this unusual course of spondylodiscitis is therefore presented here.
  
  
  METHODS
  Initially, the patient was suffering from L1-L2 spondylodiscitis caused by previous staphylococcal sepsis. After ineffective conservative antibiotic treatment, surgery was carried out, with posterior instrumentation and fusion at T11-L4 and removal and replacement of the L1 and L2 vertebral bodies.
  
  
  RESULTS
  After 2 months, the patient presented with paraparesis due to adjacent spondylodiscitis at T10-T11. The posterior instrumentation was therefore extended up to T9, and removal of the vertebral body of T11 was carried out. After 14 months, the patient was readmitted with pain and increased inflammatory parameters due to spondylodiscitis at T8/T9. Removal of the vertebral bodies was again carried out at T8 and T9, and posterior fusion up to T5 was performed. The patient received antibiotic treatment from 2 months before the first operation up to 3 months after surgery.
  
  
  CONCLUSIONS
  Newly developing spondylodiscitis adjacent to a level at which a previous spondylodiscitis has been treated surgically is a rare condition, and aggressive treatment is necessary.
authors.affiliation: Department of Orthopedics, Münster University Hospital, Münster, Germany. tobias.lange@ukmuenster.de
authors.forename: Tobias
authors.initials: T
authors.lastname: Lange
authors.forename: Tobias L
authors.initials: TL
authors.lastname: Schulte
authors.forename: Viola
authors.initials: V
authors.lastname: Bullmann
mesh_terms: D000368:Aged; D001863:Bone Screws / Q000592:standards; D003646:Debridement / Q000009:adverse effects / Q000379:methods; D015299:Discitis / Q000382:microbiology / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000592:standards; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D012008:Recurrence; D012086:Reoperation; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D013203:Staphylococcal Infections / Q000150:complications* / Q000473:pathology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control