Vaidyanathan Subramanian, Soni Bakul M, Oo Tun, Hughes Peter L, Mansour Paul, Singh Gurpreet
Spinal Injuries Unit, District General Hospital, Town Lane, Southport PR8 6PN, UK.
Cases J. 2009 Dec 21;2:9364. doi: 10.1186/1757-1626-2-9364.
We report infection of Brindley sacral anterior root stimulator in a spinal cord injury patient, who ultimately required removal of the implant. The consequences of failed implantation were severe constipation, and loss of reflex penile erection and bladder emptying.
A male patient, born in 1973, fell off the balcony while on holidays in Crete in 1993 and developed complete tetraplegia at C-5 level. In 1996, deafferentation of sacral nerve roots 2, 3 and 4 were carried out bilaterally. Brindley sacral anterior root stimulator was implanted. On eleventh post-operative day, blood stained fluid came out of sacral wound. Microbiology of exudates showed growth of Pseudomonas aeruginosa, sensitive to gentamicin. As discharge of serosanguinous fluid persisted, sacral wound was explored. In March 1997, induration and craggy swelling were noted at the site of receiver. There was discharge from the surgical wound in the back. Wound swab grew Pseudomonas aeruginosa. The receiver was taken out. Cables were retrieved and tunnelled in left flank. Laminectomy wound was left open. In May 1997, cables were removed from left flank through the laminectomy wound. Grommet was sliced down as much as possible without producing leak of cerebrospinal fluid. Histoacryl glue was used over the truncated grommet as a sealing agent. Microbiology of end of S-2 and S-3 cables showed growth of Pseudomonas aeruginosa, which was sensitive to gentamicin. End of S-4 cable showed scanty growth of Pseudomonas aeruginosa and Klebsiella aerogenes. Review of this patient in January 1999 revealed presence of sinuses in dorsal wound exuding purulent material. The wound was explored; grommet and electrodes were removed. The consequences of failed implantation were severe constipation and loss of reflex penile erection and bladder emptying. This patient had to spend increasing amount of time for bowels management. Faecal incontinence limited his mobility. The problem with his bowels was affecting his confidence in doing anything, as the slightest movement could cause his bowels to work. The inconvenience and embarrassment of a bowel accident caused distress to the patient and to his mother.
This case illustrates that bacterial infection is a major problem in spinal cord injury patients who undergo implantation of medical devices. Further, this case underlines the need for honest discussion with spinal cord injury patients about possible complications of implantation of sacral anterior root stimulator and long-term consequences of an unsuccessful operation.
我们报告了一名脊髓损伤患者的布林德利骶前根刺激器感染病例，该患者最终需要移除植入物。植入失败的后果是严重便秘、反射性阴茎勃起和膀胱排空功能丧失。
一名男性患者，出生于1973年，1993年在克里特岛度假时从阳台上坠落，导致C-5水平完全性四肢瘫痪。1996年，双侧对骶神经根2、3和4进行了去传入神经手术，并植入了布林德利骶前根刺激器。术后第11天，骶部伤口有血性液体流出。渗出物的微生物学检查显示铜绿假单胞菌生长，对庆大霉素敏感。由于血清样液体持续流出，对骶部伤口进行了探查。1997年3月，在接收器部位发现硬结和凹凸不平的肿胀。背部手术伤口有分泌物。伤口拭子培养出铜绿假单胞菌。取出了接收器。将导线取出并经隧道移至左侧腹部。椎板切除伤口敞开。1997年5月，通过椎板切除伤口从左侧腹部取出导线。尽可能多地切除索环而不导致脑脊液漏出。在截断的索环上使用组织黏合剂作为密封剂。S-2和S-3导线末端的微生物学检查显示铜绿假单胞菌生长，对庆大霉素敏感。S-4导线末端显示铜绿假单胞菌和产气克雷伯菌生长稀少。1999年1月对该患者进行复查时发现背部伤口有窦道，有脓性分泌物渗出。对伤口进行了探查；取出了索环和电极。植入失败的后果是严重便秘、反射性阴茎勃起和膀胱排空功能丧失。该患者不得不花费越来越多的时间进行肠道管理。大便失禁限制了他的活动能力。他的肠道问题影响了他做任何事情的信心，因为最轻微的动作都可能导致他排便。排便意外带来的不便和尴尬给患者及其母亲带来了困扰。
本病例表明，细菌感染是接受医疗设备植入的脊髓损伤患者面临的一个主要问题。此外，本病例强调需要与脊髓损伤患者坦诚讨论骶前根刺激器植入可能的并发症以及手术失败的长期后果。
