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Objective: Atopic dermatitis (AD) is one of the known risk factors for Staphylococcus aureus infection. The authors report the case of a patient with cervical spondylosis and AD who developed delayed surgical site infection after posterior cervical instrumented surgery.Patient: A 39-year-old male presented to our hospital with paralysis of the left upper extremity without any cause or prior injury. He had a history of severe AD. We performed C3–C7 posterior decompression and instrumented fusion based on the diagnosis of cervical spondylotic amyotrophy. One year after surgery, his deltoid and bicep muscle strength were fully recovered. Nevertheless, his neck pain worsened 2 years after surgery following worsening of AD. One month after that, he developed severe myelopathy and was admitted to our hospital. Radiographic findings showed that all the screws had loosened and the retropharyngeal space had expanded. Magnetic resonance imaging and computed tomography showed severe abscess formation and destruction of the C7/T1 vertebrae.Result: We diagnosed him with delayed surgical site infection. Methicillin-resistant Staphylococcus aureus was identified on abscess culture. The patient responded adequately to treatment with antibiotic therapy and two debridements and the infection subsided.Conclusion: We should consider the possibility of delayed surgical site infection when conducting instrumented spinal surgery in patients with severe AD.
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<p><b>OBJECTIVE</b>To explore the features and treatment strategy of delayed infection of proximal junctional zone after posterior spinal internal fixation.</p><p><b>METHODS</b>The clinical data of 1325 patients underwent posterior spinal internal fixation were retrospectively analyzed. Delayed infection occurred in 10 patients, among which 4 infections occurred at the proximal junction (non-operative site). And these 4 patients were treated with combined broad-spectrum antibiotics. Their clinical symptoms and signs, lab tests, MRI findings, pathology findings, and clinical effects were analyzed.</p><p><b>RESULTS</b>All four patients were followed up from 6 months to 4 years. No infection recurrence was found. All patients obtained satisfactory results after hospital discharge. No nerve injury was found. One patient developed kyphosis in the proximal junctional zone 2 years after the operation. According to the criteria of N.Nakano and T.Nakano, 3 cases obtained excellent results, while 1 poor.</p><p><b>CONCLUSIONS</b>The incidence rate of delayed infections was rare after spinal operation. Delayed infections occurred in proximal junctional zone may be attributed to the stress concentration of adjacent segments after fixation and the degeneration of adjacent segments, thus forming inflammation areas. For refractory lumbar and back pains, an elevated blood sedimentation rate, C-reactive protein level, MRI manifestation and focal pathology would be helpful for establishing a definite diagnosis. Full course of combined broad-spectrum antibiotics in treating the infection can lead to satisfactory clinical results.</p>
Asunto(s)
Humanos , Dolor de Espalda , Fijación Interna de Fracturas , Cifosis , Vértebras Lumbares , Región Lumbosacra , Estudios Retrospectivos , Fusión Vertebral , Infección de la Herida Quirúrgica , Quimioterapia , Epidemiología , Resultado del TratamientoRESUMEN
Objective To study the risk factors,methods of etiologic diagnosis and treatment of disunion of fracture due to delayed infection after the internal fixation. Methods The clinical data including bacterial tests, clinical manifestation and the administration of antibiotics , of 24 cases of disunion of fracture due to delayed infec-tion after the internal fixation were retrospectively analyzed. Results 22 strains of pathogenic bacteria were distin-guished with a detection rate of 91.67% in the 24 cases. 16 strains of these bacteria were gram-positive,and 6 gram-negative. The gram-positive ones were all sensitive to vancomycin and teicoplanin. The gram-negative ones were all sensitive to imipenem and meropenem. It was common for patients to take antibiotic after operation. Conclusion More infection is caused by gram-positive bacteria than by gram-negative ones. Antibiotic therapy based on the bacte-rial test is reasonable and necessary besides surgeries.
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Objective To investigate the diagnosis and treatment of delayed infection after pedicle screw internal fixation via posterior approach. Methods The management of 17 cases of delayed infection after posterior pedicle screw internal fixation was retrospectively analyzed. Imaging examination was done before operation in all the patients. In petients whose operation was done within 9 months and non-fusion of bone graft was proved, debridement and suction-irrigation were given. For the patients in whom bone graft had fused, the implant was removed, followed by debridement, irrigation, and wound closure. Specimens were taken during operation for bacteriological study. Intravenous antibiotic was given after operation in all the patients. When 3 successive bacterial culture of wound drainage were proved to be negative and total drainage fluid was less than 50ml in 24h, drainage tube was removed. Results Wounds healed in all the patients. In 8 of 12 cases wound healed after debridement and irrigation-suction. In 9 patients fusion of the bone graft was confirmed, and internal fixators were removed, followed by debridement, irrigation-suction and primary closure of the incisions. In 4 cases infection recurred 3-18 months after first stage debridement and irrigation-suction, but X-ray confirmed that there was fusion of the bone graft. In 11 of 17 cases bacterial cultures were positive. Conclusions Delayed infection is a severe complication after internal fixation of the spine. Debridement and irrigation-suction are effective in controlling infection, and at the same time, it allows fusion of the bone graft. Removal of the internal fixators is not indispensable.