A Chronic Post-Surgical Infectious Lumbar Fistula Providing Protection against Imminent Morbidity: A Case Report and Literature Review  

作　　者：Jacob L. Van Orman Paul E. Kaloostian Mojdeh Najle-Rahim Joseph L. Vanderlinden Samer S. Ghostine 

机构地区：[1]University of California Riverside School of Medicine, Riverside, CA, USA [2]Department of Neurosurgery, University of California at Riverside School of Medicine, Riverside, CA, USA [3]Department of Infectious Disease, Riverside Community Hospital, Riverside, CA, USA [4]Department of Vascular Surgery, Riverside Community Hospital, Riverside, CA, USA

出　　处：《Open Journal of Modern Neurosurgery》2017年第3期41-48,共8页现代神经外科学进展（英文）

摘　　要：Vertebral osteomyelitis (VOM) and spinal epidural abscesses (SEA) are rare infections on the spinal column, more prominently seen in intravenous drug users, diabetics and the immunosuppressed. We report an extremely rare case of a patient with a chronic history of lumbar post-surgical cutaneo-spinal fistulous infection that was unresponsive to conventional antibiotic therapy and ultimately required surgical debridement and spinal re-instrumentation. The novelty of this case was the chronic nature of the patient’s condition that was made possible only by a fortunate post-surgical cutaneo-spinal fistula that withdrew infected particles away from the neurological structures and thus prevented imminent compressive and neurological deficits, and possible eventual death. This rare case highlights the need for prompt surgical evaluation and intervention in patients with progressive VOM or SEA with associated cutaneo-spinal fistulas, especially in cases where conventional antibiotic treatments have failed. We highly recommend a low threshold for surgical debridement and hardware removal with re-instrumentation as appropriate before a spinal compressive emergency arises and/or sepsis develops.Vertebral osteomyelitis (VOM) and spinal epidural abscesses (SEA) are rare infections on the spinal column, more prominently seen in intravenous drug users, diabetics and the immunosuppressed. We report an extremely rare case of a patient with a chronic history of lumbar post-surgical cutaneo-spinal fistulous infection that was unresponsive to conventional antibiotic therapy and ultimately required surgical debridement and spinal re-instrumentation. The novelty of this case was the chronic nature of the patient’s condition that was made possible only by a fortunate post-surgical cutaneo-spinal fistula that withdrew infected particles away from the neurological structures and thus prevented imminent compressive and neurological deficits, and possible eventual death. This rare case highlights the need for prompt surgical evaluation and intervention in patients with progressive VOM or SEA with associated cutaneo-spinal fistulas, especially in cases where conventional antibiotic treatments have failed. We highly recommend a low threshold for surgical debridement and hardware removal with re-instrumentation as appropriate before a spinal compressive emergency arises and/or sepsis develops.

关 键 词：SPINAL EPIDURAL ABSCESS VERTEBRAL OSTEOMYELITIS Cutaneo-Spinal FISTULA SPINAL Reconstruction 

分 类 号：R73[医药卫生—肿瘤]