title: Multiple recurrent postoperative spinal infections due to an unrecognized presacral abscess following placement of bicortical sacral screws: case report.
abstract: Postoperative wound infections in spinal surgery remain an important complication to diagnose and treat successfully. In most cases of deep infection, even with instrumentation, aggressive soft-tissue debridement followed by intravenous antibiotics is sufficient. This report presents a patient who underwent L3-S1 laminectomy and pedicle screw placement including bicortical sacral screws. This patient went on to develop multiple (7) recurrent infections at the operative site over a 5-year period. Continued investigation eventually revealed a large presacral abscess, which remained the source of recurrent bacterial seeding via the remaining bone tracts of the bicortical sacral screws placed during the original lumbar surgery. Two years after drainage of this presacral collection via a retroperitoneal approach, the patient remains symptom free.
authors.affiliation: Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Laura
authors.initials: L
authors.lastname: Bloom
authors.affiliation: Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: S Shelby
authors.initials: SS
authors.lastname: Burks
authors.affiliation: Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Allan D
authors.initials: AD
authors.lastname: Levi
mesh_terms: D000038:Abscess / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001863:Bone Screws; D003131:Combined Modality Therapy; D003952:Diagnostic Imaging; D004322:Drainage; D006801:Humans; D007796:Laminectomy; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012447:Sacrum / Q000601:surgery*; D013122:Spinal Diseases / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery*
chemical_list: D000900:Anti-Bacterial Agents
keywords: I & D = incision and drainage; IV = intravenous; MRSA = methicillin-resistant Staphylococcus aureus; SSI = surgical site infection; instrumentation; methicillin-resistant Staphylococcus aureus; paraspinal and presacral; postoperative infection; spine