Surgical treatment for bacterial meningitis after spinal surgery: A case report

Abstract

Rationale: Bacterial meningitis (BM) has been recognized as a rare complication of spinal surgery. However, there are few reports on the management of postoperative BM in patients who have undergone spinal surgery. The initial approach to the treatment of patients suspected with acute BM depends on the stage at which the syndrome is recognized, the speed of the diagnostic evaluation, and the need for antimicrobial and adjunctive therapy.

Patient concerns: Here, we report the case of a patient with lumbar spinal stenosis and underwent a transforaminal lumbar interbody fusion at L4-L5. The dura mater was damaged intraoperatively. After the surgery, the patient displayed dizziness and vomiting. A CSF culture revealed Pseudomonas aeruginosa infection.

Diagnoses: The patient was diagnosed with postoperative BM.

Interventions: Antibiotic was administered intravenously depends on the organism isolated. Nevertheless, the patient's clinical condition continued to deteriorate. The patient underwent 2 open revision surgeries for dural lacerations and cyst debridement repair.

Outcomes: The patient's mental status returned to normal and her headaches diminished. The patient did not have fever and the infection healed.

Lessons: Surgical intervention is an effective method to treat BM after spinal operation in cases where conservative treatments have failed. Further, early surgical repair of dural lacerations and cyst debridement can be a treatment option for selected BM patients with complications including pseudomeningocele, wound infection, or cerebrospinal fluid leakage.

Figure 1

Lumbosacral MRI performed on the 18th day after posterior lumbar and interbody fusion at L4–L5. (A) Sagittal T2-weighted image showing a large amount of cerebrospinal fluid (arrows) in the lumbosacral space. (B) Axial T2-weighted MRI showing a cerebrospinal fluid cutaneous fistula (arrow). MRI = magnetic resonance imaging.

Figure 2

On the 19th day after the second operation, a large amount of cerebrospinal fluid leakage was noted on T2-weighted MRI. (A) Sagittal T2-weighted image showing a large amount of cerebrospinal fluid leakage in the lumbosacral space (arrow). (B) Axial T2-weighted MRI showing a large amount of cerebrospinal fluid leakage (arrows). MRI = magnetic resonance imaging.