title: 17-Year-Delayed Fistula Formation After Elective Spinal Instrumentation: A Case Report.
abstract: BACKGROUND
  A late-developing infection after an uneventful initial spinal instrumentation procedure is rare. Delayed infection and new fistula formation have been reported from a few months to 13 years. Here we report an unusual 17-year-delayed fistula formation after primary spinal instrumentation. The patient underwent hardware removal surgery with antibiotic therapy as a definitive treatment.
  
  
  METHODS
  Here we report an unusual 17-year delayed fistula formation after primary spinal instrumentation due to spinal trauma. He was admitted to Ghaem General Hospital, a chief referral center, Mashhad, North-East of Iran in August 2014. The patient underwent hardware removal surgery with antibiotic therapy as a definitive treatment.
  
  
  CONCLUSIONS
  Late inflammation may occur around spinal instruments and results in cutaneous fistula formation. After oral or intravenous antibiotic treatment, total device extraction is the cornerstone of treatment.
authors.affiliation: Department of Neurological Surgery, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, IR Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Etemadrezaei
authors.affiliation: Department of Neurological Surgery, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, IR Iran.
authors.forename: Samira
authors.initials: S
authors.lastname: Zabihyan
authors.affiliation: Department of Neurological Surgery, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, IR Iran.
authors.forename: Aidin
authors.initials: A
authors.lastname: Shakeri
authors.affiliation: Department of Neurological Surgery, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, IR Iran.
authors.forename: Babak
authors.initials: B
authors.lastname: Ganjeifar
keywords: Delayed; Fistula; Instrumentation