34 year old male had fall from height resulting in severe back pain. There was no associated weakness but he was not able to stand or get up due to unbearable back pain. He was taken to a nearby hospital where an MRI was done. MRI showed L1 burst fracture.
He underwent pedicle screw fixation for the fracture. Surgery was uneventful. Patient was mobilized and discharged to home after 3 days. One week after surgery patient developed pus discharge from surgery site. Repeated dressing and antibiotics was advised. After one month of surgery, patient still had pus discharging sinus in the back with severe back pain on movement. On standing now he had severe radiating pain in legs with weakness. At this stage he was referred to Jaypee Hospital for further treatment.
New xray and MRI were advised which showed Implant failure with pedicle screws backed out of bone; there was large pus collection in the para and prevertebral region. His ESR and CRP were also high.
In view of these findings, he was advised for revision surgery – Implant removal, Decompression, Debridement and refixation with extension of fixation levels. Patient was operated as planned. Pus culture grew Staph aureus and appropriate antibiotics were started. There was significant improvement in pain and weakness. Antibiotic were given for 3 months. At 3 months, ESR and CRP were normal. MRI showed complete resolution of infection.
Surgical site infections need aggressive management. Those not responding to conservative approach needs surgical intervention.
