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Bacteroides Fragilis Vertebral Osteomyelitis Complicated by Percutaneous Epidural Adhesiolysis

Han, In Ho MD*; Choi, Byung Kwan MD*; Nam, Kyoung Hyup MD*; Kim, Shine Young MD

doi: 10.1097/BRS.0b013e31828671f9
Case Report

Study Design. A case report of anaerobic vertebral osteomyelitis after percutaneous epidural adhesiolysis.

Objective. To present a case of Bacteroides fragilis spondylodiscitis (BFS) secondary to percutaneous epidural adhesiolysis in a 38-year-old woman without predisposing factors.

Summary of Background Data. Most cases of BFS result from hematogenous spread from a perianal abscess or sigmoidoscopy or local spread from an adjacent infection. However, BFS due to direct inoculation after percutaneous epidural adhesiolysis has not been previously reported.

Methods. A 38-year-old woman presented with spondylodiscitis at the L4–L5 level 2 weeks after percutaneous epidural adhesiolysis. Despite empirical antibiotherapy, the spondylodiscitis and an epidural abscess became much aggravated. Open biopsy and curettage was performed, and metronidazole sensitive Bacteroides fragilis was identified by tissue culture.

Results. Metronidazole was administrated for 5 weeks and symptoms were completely resolved. Follow-up magnetic resonance imaging showed that the spondylodiscitis was completely cured.

Conclusion. This is the first report to be issued regarding BFS secondary to percutaneous epidural adhesiolysis. In our case, the pathogenesis may have been direct inoculation of Bacteroides fragilis into the epidural space and disc during percutaneous epidural adhesiolysis because the procedural approach used was adjacent to the anus.

Anaerobic vertebral osteomyelitis after percutaneous epidural adhesiolysis is rare. We report the case of Bacteroides fragilis spondylodiscitis (BFS) secondary to percutaneous epidural adhesiolysis in a 38-year-old woman without predisposing factors. This is the first report to be issued regarding BFS secondary to percutaneous epidural adhesiolysis.

*Department of Neurosurgery; and

Department of Laboratory Medicine, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.

Address correspondence and reprint requests to Byung Kwan Choi, MD, Department of Neurosurgery, Pusan National University Hospital, 305 Gudeok-Ro Seo-Gu, Busan 602-739, Korea; E-mail: spine@pusan.ac.kr

Acknowledgment date: October 1, 2012. Acceptance date: December 19, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2013 Lippincott Williams & Wilkins, Inc.