Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
J Spinal Cord Med. 2022 Mar;45(2):311-315. doi: 10.1080/10790268.2019.1677984. Epub 2019 Oct 30.
Delayed, postoperative, spine infections are rare, most commonly occurring secondary to fastidious, less virulent pathogens. The etiology may involve a distant infectious focus, not related to the index operation. Patients may present months, or even years postoperatively with pain related to mechanical implant failure, often without additional signs of systemic infection. We present the case of a 59-year-old male who developed rapid disk degeneration and implant failure seven months following instrumented lumbar fusion surgery. The causal organism was found to be Micromonas micros, an anaerobic bacterium typically located in the oral cavity and associated with periodontal disease. The patient was found to have extensive oral caries, which were presumed to have occurred secondary to poor oral hygiene and his use of fentanyl lozenges for chronic back pain. The patient was treated with revision staged spinal surgery and long-term intravenous antibiotics. This case highlights an unusual etiology of delayed postoperative spinal implant failure and provides evidence for periodontal disease as a source of hematogenous seeding in postoperative spinal infections. The orthopaedist should also be aware of the potential relationship between poor oral hygiene and the use of high sugar content fentanyl lozenges in treating chronic back pain in these patients.
术后迟发性脊柱感染较为罕见，通常由条件致病菌引起。病因可能与远处感染灶有关，与手术本身无关。患者术后数月甚至数年可能因机械植入物失败引起疼痛，常无全身感染的其他表现。我们报告 1 例 59 岁男性，在接受腰椎融合内固定术后 7 个月出现快速椎间盘退变和植入物失败。病原菌为微小微单胞菌，一种通常存在于口腔中的厌氧菌，与牙周病有关。患者口腔龋齿广泛，推测与口腔卫生不良和使用芬太尼含片治疗慢性背痛有关。患者接受了翻修分期脊柱手术和长期静脉内抗生素治疗。该病例提示了一种迟发性术后脊柱植入物失败的不常见病因，并为牙周病作为术后脊柱感染血源性播散的来源提供了证据。矫形外科医生还应注意到，在这些患者中，口腔卫生不良和使用高糖含量芬太尼含片治疗慢性背痛之间可能存在潜在关系。
