Özdoğan Selçuk, Yaltırık Cumhur Kaan, Düzkalır Ali Haluk, Demirel Nail, Kaya Mustafa, Atalay Başar
Department of Neurosurgery, İstanbul Training and Research Hospital, Istanbul, Turkey.
Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey.
Am J Case Rep. 2018 Mar 6;19:249-253. doi: 10.12659/ajcr.907409.
BACKGROUND The aim of this study was to draw attention to rare spinal infections in recurrent failed spinal surgeries. CASE REPORT A 59-year-old female was admitted to the hospital for back pain, which was assessed as a 9 on the visual analogue scale (VAS); the patient reported tiredness and night sweats. She had an operation for L3-4 far lateral disc herniation four years ago. Then another operation for L4-5 disc herniation six months ago and immediately three months later she has an operation with L3-4-5 fixation again. She had hypothyroidism, diabetes mellitus, and hypertension. Her daughter was cured of pulmonary tuberculosis 20 years ago. We performed an operation by L4-5 discectomy; all granulation formation with inflammatory processes were debrided and irrigated with antibiotics at levels of L3-5. The old fixation was controlled and replaced. Her back pain improved immediately after surgery; she had a score of 2 on the VAS. Two days after her surgery, our Infection Disease Department reported acid resistant bacillus (ARB+) in samples and began anti-tuberculosis medication. CONCLUSIONS Spinal infections should always be taken into consideration in recurrent failed back surgeries.
背景 本研究的目的是引起人们对复发性脊柱手术失败后罕见脊柱感染的关注。
病例报告 一名59岁女性因背痛入院，视觉模拟评分（VAS）为9分；患者自述疲倦和盗汗。她四年前因L3-4远外侧椎间盘突出症接受过手术。六个月前又因L4-5椎间盘突出症接受了一次手术，三个月后立即再次接受了L3-4-5固定手术。她患有甲状腺功能减退症、糖尿病和高血压。她的女儿20年前治愈了肺结核。我们进行了L4-5椎间盘切除术；清除了L3-5节段所有伴有炎症过程的肉芽组织形成，并使用抗生素冲洗。对旧的固定装置进行了检查并更换。术后她的背痛立即改善；VAS评分为2分。术后两天，我们的感染病科报告样本中存在耐酸杆菌（ARB+），并开始抗结核治疗。
结论 在复发性脊柱手术失败的情况下，应始终考虑脊柱感染。
