Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
Spine (Phila Pa 1976). 2013 Apr 1;38(7):E431-5. doi: 10.1097/BRS.0b013e31828671f9.
A case report of anaerobic vertebral osteomyelitis after percutaneous epidural adhesiolysis.
To present a case of Bacteroides fragilis spondylodiscitis (BFS) secondary to percutaneous epidural adhesiolysis in a 38-year-old woman without predisposing factors.
Most cases of BFS result from hematogenous spread from a perianal abscess or sigmoidoscopy or local spread from an adjacent infection. However, BFS due to direct inoculation after percutaneous epidural adhesiolysis has not been previously reported.
A 38-year-old woman presented with spondylodiscitis at the L4-L5 level 2 weeks after percutaneous epidural adhesiolysis. Despite empirical antibiotherapy, the spondylodiscitis and an epidural abscess became much aggravated. Open biopsy and curettage was performed, and metronidazole sensitive Bacteroides fragilis was identified by tissue culture.
Metronidazole was administrated for 5 weeks and symptoms were completely resolved. Follow-up magnetic resonance imaging showed that the spondylodiscitis was completely cured.
This is the first report to be issued regarding BFS secondary to percutaneous epidural adhesiolysis. In our case, the pathogenesis may have been direct inoculation of Bacteroides fragilis into the epidural space and disc during percutaneous epidural adhesiolysis because the procedural approach used was adjacent to the anus.
经皮硬膜外粘连松解术后发生厌氧性脊椎骨髓炎的 1 例病例报告。
报告 1 例无诱发因素的 38 岁女性脆弱拟杆菌性脊椎椎间盘炎（BFS），由经皮硬膜外粘连松解术引起。
大多数脆弱拟杆菌性骨髓炎病例是由肛周脓肿或乙状结肠镜检查的血源性播散或来自邻近感染的局部播散引起。然而，先前尚未有报道过因经皮硬膜外粘连松解术后直接接种而导致 BFS。
1 名 38 岁女性在经皮硬膜外粘连松解术后 2 周出现 L4-L5 水平的脊椎椎间盘炎。尽管进行了经验性抗生素治疗，但脊椎椎间盘炎和硬膜外脓肿的病情恶化。进行了开放性活组织检查和刮除术，组织培养鉴定出对甲硝唑敏感的脆弱拟杆菌。
给予甲硝唑治疗 5 周后，症状完全缓解。随访磁共振成像显示脊椎椎间盘炎完全治愈。
这是首例报告经皮硬膜外粘连松解术后发生 BFS。在我们的病例中，发病机制可能是在经皮硬膜外粘连松解术期间脆弱拟杆菌直接接种到硬膜外腔和椎间盘，因为所使用的手术方法紧邻肛门。
