Hemender Singh Vats1, Fergus E McKiernan. 1. Department of General Internal Medicine, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, USA. vats.hemender@marshfieldclinic.org
Abstract
STUDY DESIGN: Case report. OBJECTIVES: To describe a case of infected vertebroplasty and to demonstrate the importance of polymerase chain reaction (PCR) in the diagnosis of such infections. SUMMARY OF BACKGROUND DATA: Infection of the vertebroplasty site is an uncommon complication of vertebroplasty. Only 4 cases have been reported in the literature so far, and an organism could be identified in only 2 of those cases. To our knowledge, the use of PCR to diagnose infection in these cases has not been reported before. METHODS: Vertebroplasty, laminectomy, radiology, fluid aspiration, microbial culture, and 16S RNA PCR. RESULTS: A 73-year-old diabetic woman underwent vertebroplasty for L2 and L3 vertebral compression fractures followed by L4-L5 laminectomy for spinal stenosis. Three months later, she had an L1 fracture that was augmented with vertebroplasty. Six months later, she presented with incapacitating low back pain. There was a fluid-filled cavity surrounding the polymethylmethacrylate in the L1 and L2 vertebral bodies. The fluid had 95,000 white blood cells with 96% neutrophils, grew nothing on culture, but had 100% homology with Streptococcus agalactiae on 16S ribosomal nucleic acid analysis. CONCLUSIONS: We report a case of infected vertebroplasty with atypical radiologic findings of vertebral infection. To our knowledge, this is the third reported case where an organism could be isolated for these infections and the first time PCR has been used to diagnose such an infection.
STUDY DESIGN: Case report. OBJECTIVES: To describe a case of infected vertebroplasty and to demonstrate the importance of polymerase chain reaction (PCR) in the diagnosis of such infections. SUMMARY OF BACKGROUND DATA: Infection of the vertebroplasty site is an uncommon complication of vertebroplasty. Only 4 cases have been reported in the literature so far, and an organism could be identified in only 2 of those cases. To our knowledge, the use of PCR to diagnose infection in these cases has not been reported before. METHODS: Vertebroplasty, laminectomy, radiology, fluid aspiration, microbial culture, and 16S RNA PCR. RESULTS: A 73-year-old diabeticwoman underwent vertebroplasty for L2 and L3 vertebral compression fractures followed by L4-L5 laminectomy for spinal stenosis. Three months later, she had an L1 fracture that was augmented with vertebroplasty. Six months later, she presented with incapacitating low back pain. There was a fluid-filled cavity surrounding the polymethylmethacrylate in the L1 and L2 vertebral bodies. The fluid had 95,000 white blood cells with 96% neutrophils, grew nothing on culture, but had 100% homology with Streptococcus agalactiae on 16S ribosomal nucleic acid analysis. CONCLUSIONS: We report a case of infected vertebroplasty with atypical radiologic findings of vertebral infection. To our knowledge, this is the third reported case where an organism could be isolated for these infections and the first time PCR has been used to diagnose such an infection.