Thoracic infectious spondylitis after surgical treatments of herniated lumbar intervertebral disc

Abstract

The postoperative infectious spondylitis has been reported to occur among every 1% to 12%. It is difficult to early diagnose in some cases. If the diagnosis is delayed, it can be a life-threatening condition. We report a 32-year-old male patient with postoperative infectious spondylitis. He had surgical treatments for traumatic intervertebral disc herniations in L3-4 and L4-5. Three weeks after surgery, he complained for fever and paraplegia. Cervicothoracic magnetic resonance imaging showed the collapsed T2 and T3 vertebral body with changes of bone marrow signal intensity. Moreover, it showed anterior and posterior epidural masses causing spinal cord compressions which suggested infectious spondylitis. After the use of antibiotics and surgical decompressions T2-T3, his general conditions were improved and muscle power of lower extremities began to be gradually restored. However, we could not identify the exact organisms that may be the cause of infectious spondylitis. It could be important that the infectious spondylitis, which is presented away from the primary operative level, should be observed in patients with fevers of unknown origin and paraplegia.

Keywords: Intervertebral disc displacement; Spinal cord compression; Spondylitis.

Fig. 1

Lumbosacral spine X-ray shows a surgical intervention of posterior instrumentation from L3 to L5 vertebrae: (A) lateral image, (B) anteroposterior image.

Fig. 2

(A) Sagittal T2-weighted magnetic resonance image of the cervicothoracic spine showing collapsed T2 and T3 vertebrae (arrow), anterior and posterior epidural mass formation, causing compressive myelopathy at T2 to T4 level. (B) Axial T2-weighted magnetic resonance image between T2 and T3 level.

Fig. 3

(A) Sagittal contrast-enhanced T1-weighted magnetic resonance image of the cervicothoracic spine showing collapsed T2 and T3 vertebrae (arrow) and enhanced anterior and posterior epidural mass formation, causing compressive myelopathy at T2 to T4 level. (B) Axial contrast-enhanced T1-weighted magnetic resonance image between T2 and T3 level.