Adjacent segment infective spondylodiscitis is a rare type of surgical spinal infection after lumbar fusion with few reports. We report a further case of adjacent segment infection after three-level lumbar fusion managed successfully with anti-infective therapy and revision surgery. Case Description. A clinical case of a 69-year-old female with multilevel lumbar degenerative disease received three-level fusion. The leading preoperative symptoms were relieved after decompression surgery. However, severe back pain recurred and prompted her to be rehospitalized 2 months later. The signal of spondylitis and discitis at the adjacent segment was detected by magnetic resonance imaging (MRI). No bacteria were identified despite blood cultures being taken before antibiotic treatment. After a long-term anti-infective therapy with vancomycin, the patient gained symptom relief and was discharged home. However, the patient complained of severe back pain again after long-term oral antibiotic treatment and was rehospitalized 6 months after surgery. The computed tomography (CT) scan showed obvious bony endplate destruction at the adjacent segment space. The patient received a debridement operation and autologous iliac bone graft. The infective inflammatory markers were controlled, and the infective space achieved fusion finally.
Adjacent segment space infection is a rare reported complication that occurs after spinal fusion surgery. Conservative antibiotic therapy may not control the infection completely, and disc space debridement and autologous iliac bone graft can achieve ultimate fusion and a satisfactory outcome.
Copyright © 2020 Wenlong Wang et al.
Conflict of interest statement
All authors declare that they have no conflicts of interest.
Decision making in surgical treatment of chronic low back pain: the performance of prognostic tests to select patients for lumbar spinal fusion.
Acta Orthop Suppl. 2013 Feb;84(349):1-35. doi: 10.3109/17453674.2012.753565.
Acta Orthop Suppl. 2013.
Adjacent intervertebral space infection after lumbar fusion.
Orthopade. 2018 Feb;47(2):170-174. doi: 10.1007/s00132-017-3522-3.
[Adjacent segment degeneration after lumbosacral fusion in spondylolisthesis: a retrospective radiological and clinical analysis].
Acta Chir Orthop Traumatol Cech. 2010 Apr;77(2):124-30.
Acta Chir Orthop Traumatol Cech. 2010.
Management of lumbar spondylodiscitis developing after laparoscopic sacrohysteropexy with a mesh: A case report and review of the literature.
Medicine (Baltimore). 2019 Dec;98(49):e18252. doi: 10.1097/MD.0000000000018252.
Medicine (Baltimore). 2019.
Free PMC article.
L5-S1 Achromobacter xylosoxidans infection secondary to oxygen-ozone therapy for the treatment of lumbosacral disc herniation: a case report and review of the literature.
Spine (Phila Pa 1976). 2014 Mar 15;39(6):E413-6. doi: 10.1097/BRS.0000000000000195.
Spine (Phila Pa 1976). 2014.
Lange T., Schulte T. L., Bullmann V. Two recurrences of adjacent spondylodiscitis after initial surgical intervention with posterior stabilization, debridement, and reconstruction of the anterior column in a patient with spondylodiscitis: a case report. Spine. 2010;35(16):E804–E810. doi: 10.1097/BRS.0b013e3181d56955.