Conservative Management of Spondylodiscitis after Laparoscopic Sacral Colpopexy: A Case Report and Review of Literature

Abstract

Sacral colpopexy is one of the standard procedures to treat apical pelvic organ prolapse. In most cases, a synthetic mesh is used to facilitate the colposuspension. Spondylodiscitis is a rare but potentially serious complication that must be promptly diagnosed and treated, despite the lack of consensus in the management of this complication. We report one case of spondylodiscitis after a laparoscopic supracervical hysterectomy and sacral colpopexy treated conservatively. We also present a literature review regarding this rare complication. A conservative approach without mesh removal may be possible in selected patients (stable, with no vaginal lesions, mesh exposure or severe neurologic compromise). Hemocultures and culture of image-guided biopsies should be performed to direct antibiotic therapy. Conservative versus surgical treatment should be regularly weighted depending on clinical and analytical progression. A multidisciplinary team is of paramount importance in the follow-up of these patients.

Spondylodiscitis after sacral colpopexy: diagnose early to treat earlier

“…Since the anterior surfaces of L5 and S1 form a sharp descending angle of 60 degrees, the L5-S1 disc rather than the actual sacrum promontory is the most noticeable structure in the surgical presacral area [22]. The time between LSC procedure and the clinical manifestation of discitis varies from a few days to years, after mesh placement [12].…”

“…The time between LSC procedure and the clinical manifestation of discitis varies from a few days to years, after mesh placement [12]. Most patients with spondylodiscitis began to exhibit symptoms less than five months following the surgery [22], and at least two cases out of every three ultimately require surgery [23]. Although theoretically possible, it is not clear whether titanium tacks increase the risk of osteomyelitis.…”

“…A recent analysis of the literature revealed that the types of antibiotics prescribed to medically treated patients varied and might range from 4 weeks to 6 months [22]. These antibiotics included vancomycin, advanced generation cephalosporins, and clindamycin [22][23][24]. Spondylodiscitis cases can occur either with positive or negative culture test [22,25,26].…”

“…These antibiotics included vancomycin, advanced generation cephalosporins, and clindamycin [22][23][24]. Spondylodiscitis cases can occur either with positive or negative culture test [22,25,26]. The predominant causative microorganisms in nearly half of all instances of pyogenic spondylodiscitis are Staphylococcus and Streptococcus species, despite the fact that cultures obtained from the infection site have a roughly 60% consistency rate with peripherical cultures [27].…”