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Deep surgical site infection after posterior instrumented fusion for rheumatoid upper cervical subluxation treated with antibiotic-loaded bone cement
- Source :
- Medicine
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
Abstract
- Introduction: Patients with rheumatoid arthritis (RA) tend to be immunosuppressed due to RA itself and the therapeutic drugs administered. The management of surgical site infection (SSI) following upper cervical spinal instrumented fusion in RA patients is challenging; however, literature on the treatment for such conditions is scarce. We report 3 consecutive patients with RA, who developed deep SSI following upper cervical posterior fusion and were treated using antibiotic-loaded bone cement (ALBC). Patient Concerns: All 3 patients reported in the current study experienced compression myelopathy with upper cervical spinal deformity and received prednisolone and methotrexate for controlling RA preoperatively. The patient in Case 1 underwent C1–2 posterior fusion and developed deep SSI due to methicillin-sensitive Staphylococcus aureus at 3 months postoperatively; the patient in Case 2 underwent occipito-C2 posterior fusion and developed deep SSI due to methicillin-sensitive Staphylococcus aureus at 2 weeks postoperatively; and the patient in Case 3 underwent occipito-C2 posterior instrumented fusion and laminoplasty at C3–7, and developed deep SSI due to methicillin-resistant coagulase negative staphylococci at 3 weeks postoperatively. Diagnosis: All patients developed deep staphylococcal SSI in the postoperative period. Interventions: All 3 patients were treated using ALBC placed on and around the instrumentation to cover them and occupy the dead space after radical open debridement. Outcomes: The deep infection was resolved uneventfully after the single surgical intervention retaining spinal instrumentation. Good clinical outcomes of the initial surgery were maintained until the final follow-up without recurrence of SSI in all 3 cases. Conclusion: ALBC embedding spinal instrumentation procedure can be a viable treatment for curing SSI in complex cases, such as patients with RA who undergo high cervical fusion surgeries without implant removal.
- Subjects :
- Adult
rheumatoid arthritis
Staphylococcus aureus
medicine.medical_specialty
medicine.drug_class
medicine.medical_treatment
Antibiotics
Joint Dislocations
Arthritis
Arthritis, Rheumatoid
03 medical and health sciences
Myelopathy
Postoperative Complications
0302 clinical medicine
medicine
Humans
Surgical Wound Infection
Clinical Case Report
030212 general & internal medicine
Aged
bone cement
Debridement
business.industry
Bone Cements
General Medicine
Middle Aged
Staphylococcal Infections
surgical site infection
Laminoplasty
medicine.disease
Bone cement
Anti-Bacterial Agents
Surgery
Spinal Fusion
upper cervical spine
030220 oncology & carcinogenesis
Rheumatoid arthritis
Prednisolone
Female
business
instrumented fusion
Research Article
medicine.drug
Subjects
Details
- ISSN :
- 15365964 and 00257974
- Volume :
- 99
- Database :
- OpenAIRE
- Journal :
- Medicine
- Accession number :
- edsair.doi.dedup.....3e64d3d36eae69e82bc68c10bb78c03e