Transform infected posterolateral spine
Courtesy of Mr. Michael Newman and Mr. Oliver Stokes, Spinal Fellow & Consultant Spinal Surgeons, Devon and Exeter NHS Foundation Trust, UK
71-year-old female with a history of Raynaud’s disease and former smoker, presented to the clinic with adult degenerative scoliosis. The patient underwent two separate surgical procedures, which included posterior screw placement followed by anterior lumbar interbody fusion (ALIF) and rod placement. Patient was discharged from follow-up after 5 years.
3 years later, the patient returned to clinic after a fall with back swelling and wound breakdown. Initial wound swab samples tested positive for Staphylococcus aureus and mixed Anaerobes. Imaging revealed a loose left T6 screw, loose T8 and T10 screws, non-union at T9 - T10, and a broken left rod at T12 - L1. A two-stage revision surgery was planned.
Pre-operative antibiotics were administered. All posterior hardware was removed and local gentamicin and vancomycin were used to treat the infection. Post-operative I.V. antibiotics were also administered. Excised sinus samples from the surgery indicated no bacterial growth. Patient was prescribed a 12 week oral course of doxycycline.
At 4 months the patient was readmitted for stage 2 revision surgery. Pre-operative antibiotics were administered. Creo screws and cobalt chrome rods were placed, and 10cc STIMULAN mixed with 1g vancomycin powder was used and placed in the posterolateral gutters. Two drains were inserted and a PICO dressing was applied. Post-operative I.V. antibiotics were administered. The patient was prescribed a 3 week oral course of doxycycline and instructed to use a cervicothoracic orthosis for 5 months.
At 5 months following stage 2 surgery, the patient was infection free with no pain. The patient was advised to continue using the cervicothoracic orthosis. At 11 months, the patient remains infection free and is ambulating without pain.
Note: See STIMULAN page for regulatory statements. MA0480R1
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