[Abscesses in the lumbo-sacral spine area - a case report]

Infection of the surgical operation site is found in approximately 3% of patients and 20% of patients undergoing urgent surgery. The occurrence of this type of complications is affected both by coexisting diseases and the presence of infection in the environment in which the patient is staying. It should also be taken into account that the bacteria found in the implanted material and surrounding tissues have the ability to adhere to the implant, creating a biofilm structure there. The presented patient is an illustration of such a problem, because after L5 laminectomy and extensive L2-L3 and L3-L4 one-sided fenestration and L2-L3-L4-L5 facetectomy, interbody bone arthrodesis and transpedicular stabilization, he reported for fever and pain in right lumbar area. In the patient, the presence of inflammatory infiltrate in the lumbar region of the lumbar tissues was found in imaging studies, with fluid reservoirs that surrounded pedicle screws and spinous processes, as well as abscesses and inflammatory changes in the spinal canal at the L4-L5 level. Empirical antibiotic therapy was ordered and decision about surgical treatment was made. A large amount of purulent and odorous secretion was evacuated at the site of previously performed laminectomy. In the postoperative period, targeted antibiotic therapy was applied based on the culture result obtained from the surgical site. The culture showed Staphylococcus aureus MSSA (methicillin-susceptible S. aureus) which was sensitive to the majority of antibiotics tested. The low effectiveness of this treatment caused the necessity to broaden the research, blood culture revealed Turicella otitidis, which was sensitive to gentamycin, vancomycin, linezolid and rifampicin. The applied rifampicin caused improvement of the patient's condition and the possibility of starting motor rehabilitation. The described case indicates real difficulties in the treatment of post-operative infections, despite invasive procedures and antibiotic therapy.

Empyema in spinal canal in thoracic region, abscesses in paravertebral space, spondylitis: in clinical course of zoonosis Erysipelothrix rhusiopathiae

OBJECTIVES

Erysipelas is an animal disease caused by Gram-positive bacteria Erysipelothrix rhusiopathiae. Among the domestic animals, domestic pig (Sus scrofa f. domestica) suffers most frequently from the disease in human environment. This is a typical animal-borne disease observed mainly in occupational groups employed in agriculture, farming (of animals and birds), fishing and manufacturing industry.

METHODS

We are presenting the clinical course of infection (E. rhusiopathiae) and discuss clinical forms. E. rhusiopathiae in humans may have the following clinical course: mild form of skin infection diagnosed as local erythema (erysipeloid), disseminated form of skin infection and the most serious form of infection of systemic course (endocarditis and sepsis). Mild skin infection and local erythema are the most common forms. Very rare case of animal-borne infection course has been presented in which after initial phase the disease was generalised to the abscesses formation in paravertebral space, spondylitis and empyema formation in spinal canal. In the presented clinical case, the patient was suffering from diabetes. It was probably an additional risk factor of the disease generalisation. Patient underwent drainage of empyema in spinal canal, after which his neurological status gradually improved. Antibiotic therapy was implemented and continued for 8 weeks. Such course of erysipelas was not previously described in the literature.

RESULTS

After therapy neurological status was improved. In follow MRI control exam empyema and spondylitis was successfully eliminated.

CONCLUSIONS

Various complications of the disease, such as endocarditis and heart valves disturbances, are well known and are the most severe complications of the generalised infection. Proper targeted and long-term antibiotic therapy is crucial.

Papilledema as a manifestation of a spinal subdural abscess

Papilledema is an uncommon presentation of spinal cord processes. Spinal subdural abscess (SSA) is a rare site of post-operative infection. We report a patient who developed papilledema as the primary manifestation of a post-operative lumbar subdural abscess. A spinal abscess should be considered in the post-operative spinal surgery patient who develops papilledema in the setting of persistent back pain. The increased intracranial pressure associated with lumbar spinal cord abscess most likely results from a markedly elevated cerebrospinal fluid (CSF) protein or the disruption of CSF flow in the spinal cul-de-sac.

Postoperative discitis due to Propionibacterium acnes: a case report and review of the literature

BACKGROUND

No previous report has described a progressive, destructive postoperative discitis requiring operative stabilization due to Propionibacterium acnes. The clinical and radiographic features and treatment options associated with discitis due to P acnes are presented in a retrospective case study, as well as a review of the current literature.

CASE DESCRIPTION

Seven weeks after a routine lumbar discectomy, the patient presented with clinical findings and radiographic imaging consistent with discitis. Intraoperative cultures obtained from irrigation and debridement of the disc space revealed P acnes, and appropriate intravenous antibiotic treatment was instituted. Approximately 2 months later, the patient showed progression to a destructive osteomyelitis requiring operative stabilization. Nine weeks after stabilization, the patient continued to have lower back pain without radiculopathy. Laboratory values had normalized. Radiographic imaging revealed good instrumentation positioning and adequate fusion. The patient was ambulatory with bilateral articulating ankle foot orthoses and a walker.

CONCLUSION

The reported case adds to the literature on postoperative discitis due to P acnes and demonstrates that this organism can occasionally be the cause of progressive, destructive osteomyelitis. In addition, we review the incidence, risk factors, and clinical course of discitis due to P acnes.

Subdural empyema with extension to vertebral canal secondary to salmonellosis in a patient with systemic lupus erythematosus

CASE REPORT

A case of supratentorial subdural empyema extending to the superior subdural cervical space in a 14-year-old patient with systemic lupus erythematosus is presented. The presumed etiology of the empyema was an intestinal nontyphoidal salmonella infection.

DISCUSSION

We review the neurological and neurosurgical complications in systemic lupus erythematosus.