Miura Isamu, Kubota Motoo, Momosaki Oji, Takebayashi Kento, Kawamata Takakazu, Yuzurihara Masahito
Department of Spinal Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa-shi, Chiba 296-8602, Japan.
Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
Case Rep Orthop. 2020 Feb 22;2020:7372821. doi: 10.1155/2020/7372821. eCollection 2020.
Spinal subdural abscesses are rare lesions. We report the case of surgical site infection complicated with meningitis and rapidly progressive spinal subdural abscess caused by following transforaminal lumbar interbody fusion (TLIF). A 72-year-old woman was admitted to our hospital complaining of drop foot syndrome and sciatica caused by stenosis of the L5/6 intervertebral foramen accompanied by L5 lumbar vertebral fracture. Accordingly, TLIF of L5-L6 and balloon kyphoplasty of L5 were performed. On the 3rd postoperative day (POD), she was diagnosed with surgical site infection complicated with bacterial meningitis. Subcutaneous fluid, blood, and cerebrospinal fluid cultures indicated . On the 7 POD, a repeat MRI showed a large dorsal fluid collection consistent with a subdural infection and massive cauda equina compression. We performed debridement and instrument removal and found a dural laceration that was not observed during the first operation. An intraoperative insensible dural laceration may cause bacteria intrusion into the subdural space.
脊髓硬膜下脓肿是罕见的病变。我们报告一例经椎间孔腰椎椎体间融合术（TLIF）后并发脑膜炎及迅速进展的脊髓硬膜下脓肿的手术部位感染病例。一名72岁女性因L5/6椎间孔狭窄伴L5腰椎骨折导致足下垂综合征和坐骨神经痛入住我院。因此，对L5-L6进行了TLIF并对L5进行了球囊后凸成形术。术后第3天（POD），她被诊断为手术部位感染并发细菌性脑膜炎。皮下液体、血液和脑脊液培养结果显示……在术后第7天，重复MRI显示一个与硬膜下感染相符的巨大背侧液体积聚以及马尾神经大量受压。我们进行了清创和内固定取出，发现了首次手术时未观察到的硬脑膜撕裂。术中隐匿性硬脑膜撕裂可能导致细菌侵入硬膜下间隙。
