Retroperitoneal continuous local antibiotic perfusion for surgical site infection after lumbar lateral interbody fusion: A case report

JOS Case Reports Pub Date : 2024-12-01 DOI:10.1016/j.joscr.2024.05.002

Yawara Eguchi , Noritaka Suzuki , Sumihisa Orita , Kazuhide Inage , Miyako Narita , Yasuhiro Shiga , Masahiro Inoue , Soichiro Tokeshi , Kohei Okuyama , Shuhei Ohyama , Yasuchika Aoki , Junichi Nakamura , Shigeo Hagiwara , Yuya Kawarai , Tsutomu Akazawa , Masao Koda , Hiroshi Takahashi , Seiji Ohtori

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Abstract

Background

Surgical site infection (SSI) after instrumented spinal surgery (ISS) is one of the most serious surgical complications. Treatment is often difficult, with many cases requiring removal of the implant.

Case presentation

An 80-year-old man developed refractory MRSA SSI after L4-5 Oblique Lateral Interbody Fusion surgery for a multiply operated back. Local debridement and retroperitoneal continuous local antibiotic perfusion (CLAP) were performed to preserve the implant. One month later, a second CLAP was performed for T6-7 suppurative spondylitis that had disseminated remotely to the thoracic spine. Following this, the lumbar spine and thoracic spine abscess, inflammatory response, and low back pain were reduced dramatically, and the implant was saved.

Conclusion

Even in the case of SSI after refractory anterior ISS, CLAP is a procedure worth trying first, as it is easy to install and manage, and will possibly control infection to preserve the implant.

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腹膜后持续局部抗生素灌注治疗腰椎外侧椎体间融合术后手术部位感染1例

背景脊柱固定手术（ISS）后手术部位感染（SSI）是最严重的手术并发症之一。治疗通常很困难，许多病例需要移除植入物。病例介绍：一名80岁男性在腰4-5斜侧体间融合术后发生难治性MRSA SSI。局部清创和腹膜后持续局部抗生素灌注（CLAP）保存种植体。1个月后，对远处扩散至胸椎的T6-7化脓性脊柱炎进行第二次CLAP治疗。在此之后，腰椎和胸椎脓肿、炎症反应和腰痛显著减少，并且保存了植入物。结论即使在难治性前路ISS后发生SSI的情况下，CLAP也是一种值得首先尝试的方法，因为它易于安装和管理，并且可能控制感染以保存种植体。

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JOS Case Reports

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