Severe Spinal Infection after Vertebral Fracture Stabilization: A Narrow Escape
Spinal cord injury is typical following fall from height. The thoracolumbar vertebra undergoes maximum fracture following trauma. A 26-year-old man was brought to the emergency department with a history of fall from height. Clinical examination showed weakness in lower limbs with the inability to pass urine. Magnetic resonance imaging (MRI) of spine done elsewhere was suggestive of loss of second lumbar (L2) vertebral body height with compression over the lower end of the cord. Computed tomography (CT) scan of the spine revealed a burst fracture of L2 vertebra with bone fragments protruding into the spinal canal. The patient was taken up for spinal decompression with stabilization. His hospital stay was uneventful, and two weeks after discharge he was readmitted with wound bulge over the operative site. We started him on intravenous antibiotics and did regular debridement of the wound. Later on, he underwent wound closure with flap rotation.
At last follow-up, he was ambulant with bladder and bowel control. During treatment, the titanium implants were left in situ. The decision for implant removal in early wound infection is at the discretion of the operating surgeon, along with the timing and nature of the disease.
20 August 2020 (online)
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- 1 Bible JE, Biswas D, Devin CJ. Postoperative infections of the spine. Am J Orthop 2011; 40 (12) E264-E271
- 2 Chaudhary SB, Vives MJ, Basra SK, Reiter MF. Postoperative spinal wound infections and postprocedural diskitis. J Spinal Cord Med 2007; 30 (05) 441-451
- 3 Collins I, Wilson-MacDonald J, Chami G. et al. The diagnosis and management of infection following instrumented spinal fusion. Eur Spine J 2008; 17 (03) 445-450
- 4 Falavigna A, Righesso Neto O, Fonseca GP, Nervo M. Management of deep wound infections in spinal lumbar fusions [in Portuguese]. Arq Neuropsiquiatr 2006; 64 (04) 1001-1004
- 5 Canavese F, Gupta S, Krajbich JI, Emara KM. Vacuum-assisted closure for deep infection after spinal instrumentation for scoliosis. J Bone Joint Surg Br 2008; 90 (03) 377-381
- 6 Dietze Jr DD, Fessler RG, Jacob RP. Primary reconstruction for spinal infections. J Neurosurg 1997; 86 (06) 981-989
- 7 Eren A, Arslan M, Hilal A, Cekin N. Deaths due to fall from a height in Adana. Adli Tıp Bülteni. 2009; 14: 12-15