Ralstonia mannitolilytica as a rare cause of spondylodiscitis following endoscopic lumbar discectomy- A report of two cases

Abstract

Ralstonia mannitolilytica is a low-virulence, gram-negative bacillus which causes opportunistic infections in immunosuppressed patients. Postoperative spondylodiscitis by R. mannitolilytica has not been reported so far. We report the management of two cases of postoperative spondylodiscitis caused by Ralstonia mannitolilytica presenting to our center within a span of one month following endoscopic lumbar discectomy at a different center. They were managed successfully by surgical debridement and appropriate antibiotics. In these two cases of R.mannitolilytica spondylodiscitis, prompt detection, and intensive treatment resulted in satisfactory outcomes in terms of fulfilling the purpose of the original surgery.

Keywords: Endoscopic lumbar discectomy; Gram-negative bacilli; Post-operative spondylodiscitis; Ralstonia mannitolilytica.

Fig. 1

Radiograph (A-anterioposterior, B- Lateral) and Computed tomography images (C-midsagittal, D-coronal, E−axial cuts) of case 1 showing narrowing of L3-L4 disc space and endplate erosion.

Fig. 2

Magnetic resonance imaging A) T2 W mid-sagittal B) T1W mid-sagittal C, D, E) Post-contrast images of case 1 showing intradiscal fluid collection with diffuse vertebral body edema at L3-L4 level with anterior epidural collection.

Fig. 3

Final follow-up radiograph (A-anterioposterior, B- Lateral), Magnetic resonance imaging (C- T2W,D- Post contrast), and Computed tomography images (E−coronal, F- midsagittal) of case 1 showing completely healed lesion at 1 year.

Fig. 4

Magnetic resonance imaging (A- T2 W mid-sagittal, B, C, D- Post-contrast images) and Computed tomography images (E-Midsagittal, F- Coronal) of case 2 showing intradiscal fluid collection with the erosion of adjacent endplates at L4-L5 level, L5 sacralized.

Fig. 5

Final follow-up radiograph (A-anterioposterior, B- Lateral), Magnetic resonance imaging (C- T2W, D - Post contrast), and Computed tomography (E−midsagittal, F- coronal) images of case 2 showing completely healed lesion at 1 year.