title: L5-S1 Achromobacter xylosoxidans infection secondary to oxygen-ozone therapy for the treatment of lumbosacral disc herniation: a case report and review of the literature.
abstract: METHODS
  Case report and literature review.
  
  
  OBJECTIVE
  To present a unique case of Achromobacter xylosoxidans infection secondary to oxygen-ozone therapy for the treatment of L5-S1 disc herniation.
  
  
  BACKGROUND
  Oxygen-ozone therapy is a minimally invasive technique for the treatment of lumbar disc herniations, with unproven efficacy and few reported complications. Achromobacter xylosoxidans is an opportunistic pathogen that inhabits aquatic environments and is a rare cause of osteomyelitis. To the best of our knowledge, this is the first report of A. xylosoxidans spondylodiscitis in the lumbar spine and the third report of spinal infection after intradiscal oxygen-ozone chemonucleolysis in the English literature.
  
  
  METHODS
  The medical records, operative reports, and radiographical imaging studies of a single patient were retrospectively reviewed.
  
  
  RESULTS
  A 29-year-old female patient who previously underwent oxygen-ozone therapy for L5-S1 disc herniation presented to our institution with a 5-month history of intractable back and leg pain. The patient's laboratory studies were within normal limits and did not indicate signs of an active infection. Her physical examination revealed globally decreased muscle strength (4/5) and hyperesthesia in the lower extremities. Magnetic resonance imaging and computed tomography revealed severe disc degeneration and vertebral body endplate changes at L5-S1, in addition to paravertebral soft tissue swelling consistent with a previous infection. Given the severity of symptoms, the patient underwent anterior lumbar interbody fusion and posterior segmental instrumentation at L5-S1. Histopathological evaluation of the disc material confirmed the diagnosis of chronic osteomyelitis and septic discitis at L5-S1. Intraoperative cultures grew A. xylosoxidans and Propionibacterium acnes. The patient had prompt improvement in her level of pain and was discharged on a 6-week course of piperacillin-tazobactam without complication.
  
  
  CONCLUSIONS
  This first report of A. xylosoxidans vertebral infection secondary to oxygen-ozone therapy illustrates the wide variety of environmental pathogens that can complicate the percutaneous treatment of degenerative vertebral disease.
authors.affiliation: Departments of *Orthopaedic Surgery, Spine and Scoliosis Service; and †Internal Medicine, Infectious Diseases, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Fort
authors.forename: Alexander
authors.initials: A
authors.lastname: Aichmair
authors.forename: Andy O
authors.initials: AO
authors.lastname: Miller
authors.forename: Federico P
authors.initials: FP
authors.lastname: Girardi
mesh_terms: D042441:Achromobacter denitrificans / Q000302:isolation & purification*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015299:Discitis / Q000175:diagnosis / Q000382:microbiology*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D006801:Humans; D007278:Injections, Spinal; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D007404:Intervertebral Disc Chemolysis / Q000009:adverse effects*; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D010126:Ozone / Q000008:administration & dosage*; D012447:Sacrum / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D013123:Spinal Fusion; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010126:Ozone