A Case of Refractory Salmonella Spondylodiscitis in an Immunocompetent Patient Treated Via an Extracavitary Approach, Corpectomy and Placement of Expandable Cage

Abstract

Problem statement: Salmonella spondylodiscitis is a rare condition that is more prevalent in patients with sickle cell disease or immunosuppression. However, it can also be found in immunocompetent patients. It usually responds well to proper antibiotics. However, surgery is rarely indicated when the infection is refractory to antibiotics, the spine is destabilized or there is an epidural component that is compressing the thecal sac and causing neurological deficit. We report the case of a 60 year-old African American woman with borderline diabetes mellitus controlled with diet, who presented with Salmonella osteomyelitis of the thoracic spine that was associated with an epidural abscess. Approach: The patient presented to an outside hospital with diarrhea, fever and chills. This occurred after eating a chicken sandwich. Stool and blood cultures were positive for Salmonella. Initially she was placed on triple antibiotics (ceftriaxone, vancomycin and levofloxacin) and was later switched to levofloxacin alone given that the bacteria were sensitive to this drug. Several weeks later, she presented with severe back pain. Imaging studies showed a significant lytic lesion in her thoracic spine at T11-12 with an epidural component. Given the instability of the lesion and the failure of medical treatment a decision was made for surgical intervention. Results: She underwent an extracavitary approach for partial T11-T12 corpectomies and fusion with instrumentation with continuous administration of the proper antibiotics. The patient was then discharged to an acute patient rehabilitation center. Postoperatively, she was able to ambulate with full strength in her extremitiesand her back pain had resolved. Conclusion/Recommendations: To the best of the authors' knowledge this is the first reported case of Salmonella spondylodiscitis in an immunocompetent patient treated with a corpectomy via an extracavitary approach with the use of an expandable cage and posterior instrumentation.

Spondylodiscitis due to Sallmonela in an Immunocompetent patient

“…MRI ten days after beginning complains, showed irregular margin associated with an oedema of the L5 vertebral body and hypersignals in L5-S1 intervertebral disc, but without epidural abscess and surgery intervention as in (8,11). In osteomyelitis patients without sickle-cell anemia the infection is attributed to Salmonella in only 0.5% of the cases, one forth of which involves the spinal column (9). The most common infection sites of typhoid spondylitis were the lumbar region (5) and our case was one of them.…”