Surgical treatment for bacterial meningitis after spinal surgery: A case report.
Surgical treatment for bacterial meningitis after spinal surgery: A case report.
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DOI：
10.1097/md.0000000000006099
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发表时间：
2017-03
期刊：
影响因子：
1.6
通讯作者：
Zhou JL
中科院分区：
文献类型：
--
作者：
Zhang LM;Ren L;Zhao ZQ;Zhao YR;Zheng YF;Zhou JL
细菌性脑膜炎（BM）是脊柱手术的一种罕见并发症。然而，很少有关于脊柱手术患者术后BM管理的报道。对疑似急性BM患者的初始治疗方法取决于综合征被识别的阶段、诊断评估的速度以及对抗菌和预防治疗的需求。在这里，我们报告的情况下，患者腰椎管狭窄症，并接受了经椎间孔腰椎椎间融合在L4-L5。术中硬脑膜受损。手术后，患者出现头晕和呕吐。CSF培养显示铜绿假单胞菌感染。患者被诊断为术后BM。静脉注射抗生素取决于分离的微生物。然而，患者的临床状况继续恶化。患者接受了2次开放性翻修手术，用于硬脑膜撕裂和囊肿清创修复。患者精神状态恢复正常，头痛减轻。患者未出现发热，感染愈合。在保守治疗无效的情况下，手术干预是治疗脊柱手术后BM的有效方法。此外，硬脑膜撕裂伤的早期手术修复和囊肿清创术可以作为患有并发症（包括假性脑膜膨出、伤口感染或脑脊液漏）的BM患者的治疗选择。
Bacterial meningitis (BM) has been recognized as a rare complication of spinal surgery. However, there are few reports on the management of postoperative BM in patients who have undergone spinal surgery. The initial approach to the treatment of patients suspected with acute BM depends on the stage at which the syndrome is recognized, the speed of the diagnostic evaluation, and the need for antimicrobial and adjunctive therapy. Here, we report the case of a patient with lumbar spinal stenosis and underwent a transforaminal lumbar interbody fusion at L4–L5. The dura mater was damaged intraoperatively. After the surgery, the patient displayed dizziness and vomiting. A CSF culture revealed Pseudomonas aeruginosa infection. The patient was diagnosed with postoperative BM. Antibiotic was administered intravenously depends on the organism isolated. Nevertheless, the patient's clinical condition continued to deteriorate. The patient underwent 2 open revision surgeries for dural lacerations and cyst debridement repair. The patient's mental status returned to normal and her headaches diminished. The patient did not have fever and the infection healed. Surgical intervention is an effective method to treat BM after spinal operation in cases where conservative treatments have failed. Further, early surgical repair of dural lacerations and cyst debridement can be a treatment option for selected BM patients with complications including pseudomeningocele, wound infection, or cerebrospinal fluid leakage.