title: Bacteroides fragilis vertebral osteomyelitis complicated by percutaneous epidural adhesiolysis.
abstract: METHODS
  A case report of anaerobic vertebral osteomyelitis after percutaneous epidural adhesiolysis.
  
  
  OBJECTIVE
  To present a case of Bacteroides fragilis spondylodiscitis (BFS) secondary to percutaneous epidural adhesiolysis in a 38-year-old woman without predisposing factors.
  
  
  BACKGROUND
  Most cases of BFS result from hematogenous spread from a perianal abscess or sigmoidoscopy or local spread from an adjacent infection. However, BFS due to direct inoculation after percutaneous epidural adhesiolysis has not been previously reported.
  
  
  METHODS
  A 38-year-old woman presented with spondylodiscitis at the L4-L5 level 2 weeks after percutaneous epidural adhesiolysis. Despite empirical antibiotherapy, the spondylodiscitis and an epidural abscess became much aggravated. Open biopsy and curettage was performed, and metronidazole sensitive Bacteroides fragilis was identified by tissue culture.
  
  
  RESULTS
  Metronidazole was administrated for 5 weeks and symptoms were completely resolved. Follow-up magnetic resonance imaging showed that the spondylodiscitis was completely cured.
  
  
  CONCLUSIONS
  This is the first report to be issued regarding BFS secondary to percutaneous epidural adhesiolysis. In our case, the pathogenesis may have been direct inoculation of Bacteroides fragilis into the epidural space and disc during percutaneous epidural adhesiolysis because the procedural approach used was adjacent to the anus.
authors: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors: In Ho
authors: IH
authors: Han
authors: Byung Kwan
authors: BK
authors: Choi
authors: Kyoung Hyup
authors: KH
authors: Nam
authors: Shine Young
authors: SY
authors: Kim
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D001442:Bacteroides Infections / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D001441:Bacteroides fragilis / Q000302:isolation & purification*; D002442:Ceftazidime / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003475:Curettage; D015299:Discitis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D020802:Epidural Abscess / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D017116:Low Back Pain / Q000209:etiology; D008159:Lumbar Vertebrae / Q000382:microbiology* / Q000601:surgery; D008161:Lumbosacral Region / Q000382:microbiology; D008279:Magnetic Resonance Imaging; D008795:Metronidazole / Q000009:adverse effects / Q000627:therapeutic use; D009428:Netilmicin / Q000627:therapeutic use; D010019:Osteomyelitis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced; D013530:Surgical Wound Infection / Q000209:etiology* / Q000382:microbiology; D000267:Tissue Adhesions / Q000601:surgery*
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D009428:Netilmicin; D002442:Ceftazidime