Sequential endoscopic and robot-assisted surgical solutions for a rare fungal spondylodiscitis, secondary lumbar spinal stenosis, and subsequent discal pseudocyst causing acute cauda equina syndrome: a case report

January 30, 2022

doi: 10.1186/s12893-022-01493-3.

Affiliations

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Chao Wang et al.

BMC Surg.

2022.

Abstract

Background:

Fungal spondylodiscitis is a rare infectious disease. The secondary lumbar spinal stenosis and postoperative discal pseudocyst were even rarer. The surgical interventions were disputed, yet endoscopic and robot-assisted techniques may be helpful under different circumstances.

Case presentation:

A 62-year-old female was diagnosed as infectious spondylodiscitis at the L4/5 level and a posterolateral endoscopic debridement was performed after invalid conservative therapy. Causative organism culture revealed a rare fungus, Candida tropicalis. A secondary spinal stenosis with refractory radiculopathy occurred almost 3 years after the first surgery and a successful endoscopic surgery was implemented aiming to decompress the nerve in a minimally invasive way. However, 2 months later, the patient manifested severe acute cauda equina syndrome and radiological examinations suggested a rare postoperative discal pseudocyst. A laminectomy followed by a pseudocystectomy was applied to achieve thorough decompression. An innovative double trajectory system (simultaneous traditional pedicle screw and cortical bone trajectory screw) accompanied by posterolateral fusion was designed and executed by the professional robot-assisted system.

Conclusion:

Endoscopic and robot-assisted techniques may provide alternative solutions for fungal spondylodiscitis and accompanied sequelae.

Keywords:

Cortical bone trajectory; Discal pseudocyst; Endoscopic surgery; Fungal spondylodiscitis; Pedicle screw; Robot-assisted surgery.

References

1. Duarte RM, Vaccaro AR. Spinal infection: state of the art and management algorithm. Eur Spine J. 2013;22(12):2787–99.
  
  –
  
  DOI
1. Ganesh D, Gottlieb J, Chan S, Martinez O, Eismont F. Fungal infections of the spine. Spine (Phila Pa 1976). 2015;40(12):E719–28.
  
  –
  
  DOI
1. Kim CW, Perry A, Currier B, Yaszemski M, Garfin SR. Fungal infections of the spine. Clin Orthop Relat Res. 2006;444:92–9.
  
  –
  
  DOI
1. Choi EJ, Kim SY, Kim HG, Shon HS, Kim TK, Kim KH. Percutaneous endoscopic debridement and drainage with four different approach methods for the treatment of spinal infection. Pain Physician. 2017;20(6):E933–40.
  
  –
  
  PubMed
1. Ito M, Abumi K, Kotani Y, Kadoya K, Minami A. Clinical outcome of posterolateral endoscopic surgery for pyogenic spondylodiscitis: results of 15 patients with serious comorbid conditions. Spine (Phila Pa 1976). 2007;32(2):200–6.
  
  –
  
  DOI