TITLE:
A Chronic Post-Surgical Infectious Lumbar Fistula Providing Protection against Imminent Morbidity: A Case Report and Literature Review
AUTHORS:
Jacob L. Van Orman, Paul E. Kaloostian, Mojdeh Najle-Rahim, Joseph L. Vanderlinden, Samer S. Ghostine
KEYWORDS:
Spinal Epidural Abscess, Vertebral Osteomyelitis, Cutaneo-Spinal Fistula, Spinal Reconstruction
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.7 No.3,
June
23,
2017
ABSTRACT: Vertebral osteomyelitis (VOM) and spinal epidural
abscesses (SEA) are rare infections on the spinal column, more prominently seen
in intravenous drug users, diabetics and the immunosuppressed. We report an
extremely rare case of a patient with a chronic history of lumbar post-surgical cutaneo-spinal fistulous infection that was
unresponsive to conventional antibiotic therapy and ultimately required surgical debridement and spinal re-instrumentation.
The novelty of this case was the chronic nature of the patient’s condition that
was made possible only by a fortunate post-surgical cutaneo-spinal
fistula that withdrew infected particles away from the neurological structures
and thus prevented imminent compressive and neurological deficits, and possible eventual
death. This rare case highlights the need for prompt surgical evaluation and
intervention in patients with progressive VOM or SEA with associated cutaneo-spinal fistulas, especially in cases where
conventional antibiotic treatments have failed. We highly recommend a low threshold
for surgical debridement and hardware removal with re-instrumentation as
appropriate before a spinal compressive emergency arises and/or sepsis
develops.