Delayed surgical site infection after posterior cervical instrumented surgery in a patient with atopic dermatitis: a case report

Hiroshi Takahashi; Yasuchika Aoki; Shinji Taniguchi; Arata Nakajima; Masato Sonobe; Yorikazu Akatsu; Junya Saito; Manabu Yamada; Yasuhiro Shiga; Kazuhide Inage; Sumihisa Orita; Yawara Eguchi; Satoshi Maki; Takeo Furuya; Tsutomu Akazawa; Masao Koda; Masashi Yamazaki; Seiji Ohtori; Koichi Nakagawa

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Delayed surgical site infection after posterior cervical instrumented surgery in a patient with atopic dermatitis: a case report

VernacularTitle:Delayed surgical site infection after posterior cervical instrumented surgery in a patient with atopic dermatitis: a case report
Author: Hiroshi TAKAHASHI ¹ ; Yasuchika AOKI ² ; Shinji TANIGUCHI ³ ; Arata NAKAJIMA ¹ ; Masato SONOBE ¹ ; Yorikazu AKATSU ¹ ; Junya SAITO ¹ ; Manabu YAMADA ¹ ; Yasuhiro SHIGA ¹ ; Kazuhide INAGE ⁴ ; Sumihisa ORITA ⁴ ; Yawara EGUCHI ⁴ ; Satoshi MAKI ⁴ ; Takeo FURUYA ⁴ ; Tsutomu AKAZAWA ⁴ ; Masao KODA ⁵ ; Masashi YAMAZAKI ² ; Seiji OHTORI ² ; Koichi NAKAGAWA ⁴
Author Information

1. Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Japan
2. Department of Orthopaedic Surgery, University of Tsukuba, Japan
3. Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Japan
4. Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Japan
5. Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Japan
Keywords: surgical site infection; delayed infection; instrumented spinal surgery; atopic dermatitis
From:Journal of Rural Medicine 2020;15(3):124-129
CountryJapan
Language:English
Abstract: Objective: Atopic dermatitis (AD) is one of the known risk factors for Staphylococcus aureus infection. The authors report the case of a patient with cervical spondylosis and AD who developed delayed surgical site infection after posterior cervical instrumented surgery.Patient: A 39-year-old male presented to our hospital with paralysis of the left upper extremity without any cause or prior injury. He had a history of severe AD. We performed C3–C7 posterior decompression and instrumented fusion based on the diagnosis of cervical spondylotic amyotrophy. One year after surgery, his deltoid and bicep muscle strength were fully recovered. Nevertheless, his neck pain worsened 2 years after surgery following worsening of AD. One month after that, he developed severe myelopathy and was admitted to our hospital. Radiographic findings showed that all the screws had loosened and the retropharyngeal space had expanded. Magnetic resonance imaging and computed tomography showed severe abscess formation and destruction of the C7/T1 vertebrae.Result: We diagnosed him with delayed surgical site infection. Methicillin-resistant Staphylococcus aureus was identified on abscess culture. The patient responded adequately to treatment with antibiotic therapy and two debridements and the infection subsided.Conclusion: We should consider the possibility of delayed surgical site infection when conducting instrumented spinal surgery in patients with severe AD.