Abstract
The authors describe a 67-year-old man with a prior history of alcohol abuse who presented with a complaint of worsening low back pain. Four months prior to his presentation, the patient had undergone extreme lateral interbody fusion (XLIF) of his lumbar 3-4 segment for the treatment of his chronic low back and legs pain. Imaging revealed a loosening of his interbody fusion implant on top of his prior lumbar spine instrumentation. In surgery, the removal of his loose implant was followed by decompression, the stabilization of the collapsed segment, and the implant of antibiotic-impregnated polymethyl-methacrylate (PMMA) spacer and beads. At a later stage, the patient underwent an interbody fusion of the affected segment as well as a segmental fusion from T10 to his pelvis. Whereas all aerobes and anaerobes stains were negative for organisms, multiple fungal smears from the failed segment were positive for yeast, and the patient was placed on oral fluconazole. Infections complicating the surgical site of interbody fusions performed by minimally invasive techniques are rare. To the best of our knowledge and after reviewing the literature, this is the first report of an extreme lateral interbody fusion implant complicated by fungal osteomyelitis.
Highlights
Invasive surgery (MIS) has substantially evolved in recent years, allowing both decompression and stabilization in a variety of conditions affecting the spine [1]
To the best of our knowledge and after reviewing the literature, this is the first report of an extreme lateral interbody fusion implant complicated by fungal osteomyelitis
Among the reported advantages of Minimally invasive surgery (MIS) over the traditional open approach is the lower incidence of surgical site infections (SSI), with some reports citing an almost six-fold decrease in the likelihood of acquiring SSI with the former [2]
Summary
Invasive surgery (MIS) has substantially evolved in recent years, allowing both decompression and stabilization in a variety of conditions affecting the spine [1]. Relevant past surgical history was positive for prior L4-S1 posterior and interbody fusion performed in 2012 and a recent extreme lateral interbody fusion (XLIF) of L3-4, performed four months prior to his presentation for adjacent segment degeneration and stenosis. In addition to adjacent spinal stenosis noted in the T2 sequence (left), the L3 vertebral body shows increased contrast uptake (white asterisk), highly suggestive of infection. Removing of the existing hardware, including the L3-4 XLIF, was followed by instrumentation from L2-S1 and the placement of a cement spacer in the L3-4 disc space. The removal of the PMMA spacer and beads and irrigation was followed by a definite fusion of both the L3-4 segment as well as from T10 to his pelvis (Figure 4). The temporary PMMA spacer was replaced by an interbody fusion and the previous instrumentation extended to T10 and to the pelvis
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