Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2021; 9(15): 3637-3643
Published online May 26, 2021. doi: 10.12998/wjcc.v9.i15.3637
Postoperative pain due to an occult spinal infection: A case report
Michiel Frederik Vande Kerckhove, Vincent Fiere, Thais Dutra Vieira, Sami Bahroun, Marc Szadkowski, Henri d'Astorg
Michiel Frederik Vande Kerckhove, Vincent Fiere, Thais Dutra Vieira, Sami Bahroun, Marc Szadkowski, Henri d'Astorg, Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
Author contributions: Vande Kerckhove MF, Fiere V, Vieira TD, Bahroun S, Szadkowski M, and d'Astorg H substantially contributed to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; Vande Kerckhove MF, Vieira TD, Szadkowski M, and d’Astorg H drafted the work or revising it critically for important intellectual content; all authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; and all authors made final approval of the version to be published.
Informed consent statement: The patient was informed that data concerning the case would be submitted for publication: COS-RGDS-2020-04-002) and gave his consent.
Conflict-of-interest statement: One or more of the authors has declared a potential conflict of interest: d'Astorg H reports personal fees from Clariance, outside the submitted work; Fiere V reports personal fees from Clariance, personal fees from Medicrea, outside the submitted work; Szadkowski M reports personal fees from Clariance, outside the submitted work.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Thais Dutra Vieira, MD, Research Scientist, Surgeon, Centre Orthopedique Santy, 24 Avenue Paul Santy, Lyon 69008, France. thaisdutravieira@hotmail.com
Received: October 7, 2020
Peer-review started: October 7, 2020
First decision: November 14, 2020
Revised: December 28, 2020
Accepted: March 19, 2021
Article in press: March 19, 2021
Published online: May 26, 2021
Processing time: 209 Days and 20.1 Hours
Abstract
BACKGROUND

A high degree of vigilance is warranted for a spinal infection, particularly in a patient who has undergone an invasive procedure such as a spinal injection. The average delay in diagnosing a spinal infection is 2-4 mo. In our patient, the diagnosis of a spinal infection was delayed by 1.5 mo.

CASE SUMMARY

A 60-year-old male patient with a 1-year history of right-sided lumbar radicular pain failed conservative treatment. Six weeks to prior to surgery he received a spinal injection, which was followed by increasing lumbar radicular pain, weight loss and chills. This went unnoticed and surgery took place with right-sided L4-L5 combined microdiscectomy and foraminotomy via a posterior approach. The day after surgery, the patient developed left-sided lumbar radicular pain. Blood cultures grew Staphylococcus aureus (S. aureus). Magnetic resonance imaging showed inflammatory aberrations, revealing septic arthritis of the left-sided L4/L5 facet joint as the probable cause. Revision surgery took place and S. aureus was isolated from bacteriological samples. The patient received postoperative antibiotic treatment, which completely eradicated the infection.

CONCLUSION

The development of postoperative lower back pain and/or lumbar radicular pain can be a sign of a spinal infection. A thorough clinical and laboratory work-up is essential in the preoperative evaluation of patients with spinal pain.

Keywords: Arthritis; Septic; Lumbar region; Disc herniated; Spinal injections; Case report

Core Tip: This is the case report of a 60-year-old male patient with right-sided L4-L5 Lumbar disc herniation who underwent right-sided transforaminal injection with no improvement and a decision was made to carry out surgery. On day 1 postoperatively he developed excruciating left-sided lumbar radicular pain. Investigations and retrospective analyses demonstrated left-sided septic L4-L5 facet joint arthritis caused by Staphylococcus aureus, most probably as a result of the spinal injections 6 wk prior to surgery. The infection was successfully treated with revision surgery and antibiotic therapy.