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脊柱手术后细菌性脑膜炎的严重形式:一例病例报告及文献综述

Severe Form of Bacterial Meningitis After Spine Surgery: A Case Report and Review of the Literature.

作者信息

Gupta Anuj, Bansal Kuldeep, Chhabra Harvinder Singh, Shahi Pratyush

机构信息

Orthopaedics and Spine, Triveni Ortho & Spine Center, Delhi, IND.

Spine Surgery, Indian Spinal Injuries Center, Delhi, IND.

出版信息

Cureus. 2021 Mar 14;13(3):e13877. doi: 10.7759/cureus.13877.

Abstract

Meningitis after spine surgery is a rare complication. In this report, we aim to discuss the case of a male patient who developed this rare condition after undergoing cervical spine surgery with devastating outcomes. We also engage in a review of the relevant literature. A 17-year-old boy presented with post-traumatic cervical kyphotic deformity with signs of cord compression. He was operated in three stages, all conducted in a single sitting. There was an incidental cerebrospinal fluid (CSF) leak, which was primarily repaired. On the fourth postoperative day, the patient developed altered sensorium and seizures. Evaluations for clinical signs of meningitis such as neck rigidity and Kernig's sign were inconclusive. CSF analysis confirmed the diagnosis of meningitis. Thereafter, the patient developed hydrocephalus and intractable infection, for which multiple procedures were done. Finally, we succeeded in controlling the infection, but the patient developed a neurological deficit, which did not resolve even after 2.5 years of follow-up. The clinical signs and symptoms of meningitis after cervical spine surgery are not very clear or suggestive. A strong index of suspicion should be maintained for the early detection of this condition to prevent devastating complications that result from it.

摘要

脊柱手术后发生脑膜炎是一种罕见的并发症。在本报告中,我们旨在讨论一名男性患者在接受颈椎手术后出现这种罕见病症并导致严重后果的病例。我们还对相关文献进行了综述。一名17岁男孩因创伤后颈椎后凸畸形并伴有脊髓受压体征前来就诊。他分三个阶段进行了手术,所有手术均在一次手术中完成。术中意外发生脑脊液漏,主要进行了修补。术后第四天,患者出现意识改变和癫痫发作。对脑膜炎临床体征如颈部强直和克尼格征的评估结果不明确。脑脊液分析确诊为脑膜炎。此后,患者出现脑积水和顽固性感染,为此进行了多次手术。最后,我们成功控制了感染,但患者出现了神经功能缺损,即使经过2.5年的随访也未恢复。颈椎手术后脑膜炎的临床体征和症状并不十分明确或具有提示性。应高度怀疑以早期发现这种病症,防止由此导致的严重并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4da5/8043217/6f93bdbfc845/cureus-0013-00000013877-i01.jpg

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