Secondary Infection/Microbial Substitution in a Managed Case of Pyogenic Spondylitis

August 24, 2021

Case Reports

. 2021 Jul 16;13(7):e16432.

doi: 10.7759/cureus.16432.

eCollection 2021 Jul.

Affiliations

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Case Reports

Kengo Fujii et al.

Cureus.

2021.

Abstract

Pyogenic spondylitis is a challenging condition that requires early and accurate diagnosis for appropriate treatment. Most cases can be treated non-surgically or with minimally invasive surgical procedures; however, a combination of anterior debridement/bone grafting and posterior fixation is necessary for severe cases. We encountered a case of lumbar pyogenic spondylitis treated with anterior debridement and autogenous bone grafting after percutaneous endoscopic discectomy drainage (PEDD) with percutaneous pedicle screw (PPS) fixation. The continuous pus oozing from the PEDD drainage tube wound was characteristic in this case, and the pus was considered to be caused by secondary infection/microbial substitution. The discharge immediately stopped and healed after anterior debridement and autogenous bone grafting. Escherichia coli was first detected as the causative bacterium, and Corynebacterium amycolatum and Corynebacterium striatum were detected as the cause of secondary infection/microbial substitution. The possibility of secondary infection/microbial substitution should be considered when the clinical course worsens.

Keywords:

anterior debridement fusion; percutaneous endoscopic discectomy; posterior percutaneous fixation; pyogenic spondylitis; secondary infection.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

**Figure 1. Clinical course and antibiotic administration schematic and graph of the blood test results.**

The graph shows the changes in the laboratory data, including the white blood cells (WBC) and C-reactive proteins (CRP). Bars and arrows below the graph show the time points of antibiotic administration: (A) first surgery; (B) posterior fusion and percutaneous endoscopic lumbar discectomy/debridement (PELD); (C) anterior debridement/grafting; and (D) discharge from hospital. CMZ, cefmetazole sodium; TAZ/PIPC, tazobactam/piperacillin; CTRX, ceftriaxone sodium; TEIC, teicoplanin

**Figure 2. Enhanced computed tomography scan slices.**

(A) Axial slice shows an enhanced lesion around the L4 vertebral body and right psoas muscle, suggesting the focus of infection. (B) Coronal slice shows an enhanced lesion in the right psoas muscle, suggesting psoas abscess. (C) Sagittal bone quality slice shows no destructive changes in the L3/4 endplates and vertebral bodies.

**Figure 3. Gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA)-enhanced lumbar images obtained with magnetic resonance imaging.**

(A) Sagittal T2-weighted fat-suppressed image shows high-intensity changes in the L3 and L4 vertebral bodies. (B) Sagittal T1-weighted fat-suppressed image shows low-intensity changes in the L3 and L4 vertebral bodies. (C) Sagittal Gd-DTPA-enhanced T1-weighted image shows enhancement in the L3 and L4 vertebral bodies, anterior paravertebral soft tissue, and epidural abscess at the L3 vertebra level.

**Figure 4. Secondary computed tomography scan slices after four weeks of antibiotics administration.**

(A) Sagittal slice. (B) Coronal slice. Progressive destructive changes of the L3 and L4 endplates and vertebral body were observed.

**Figure 5. Secondary images obtained with magnetic resonance imaging.**

(A) Sagittal T2-weighted fat-suppressed image. (B) Sagittal T1-weighted image. Fluid collection in the intervertebral disc space and diffuse signal changes in the L3 and L4 vertebral bodies with destructive changes were observed.

**Figure 6. Postoperative X-ray images of posterior percutaneous screw fixation from T10 to the pelvis and percutaneous endoscopic discectomy/debridement to L3/4.**

(A) Anteroposterior X-ray image. (B) Lateral X-ray image.

**Figure 7. Postoperative X-ray of anterior debridement and autogenous bone grafting to L3/4.**

(A) Anteroposterior X-ray image. (B) Lateral X-ray image.

**Figure 8. Postoperative computed tomography (CT) images of anterior debridement and autogenous bone grafting to L3/4.**

(A) Sagittal CT image. (B) Coronal CT image.

**Figure 9. Postoperative scars**

(A) Scars after posterior percutaneous pedicle screw fixation. (B) Scar after percutaneous endoscopic discectomy/debridement. (C) Scar after anterior debridement and autogenous bone grafting.

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