Thoracic Kyphotic Deformity Secondary to Old Pseudomonas aeruginosa Spondylodiscitis in an Immunocompromised Patient With Persistent Infection Foci—A Case Report

Abstract

Background

Kyphosis secondary to pyogenic spondylodiscitis is rare and its management can be very challenging.

Methods

In this report, we present the case of a 28-year-old woman, with past history of type 1 diabetes and kidney failure on hemodialysis. Her current complaint is chronic middle and low back pain with kyphotic attitude. She had undergone posterior fixation for T12 fracture 3 years earlier, which was complicated by surgical site infection to Pseudomonas aeruginosa, with secondary kyphosis proximally. X-ray showed a 64° kyphosis with complete fusion between T8 and T10, and MRI showed persistent infection foci.

Results

The patient underwent a pedicle subtraction osteotomy at the level of T9 with instrumentation from T5 to L1. Thoracic kyphosis was corrected to 39°. Samples taken from the remaining collections returned positive for multidrug-resistant Pseudomonas aeruginosa, and the patient was kept on intravenous antibiotic (Colistine) for 2 months. She could walk on day 1, with a satisfactory clinical and radiological result at 3 years.

Conclusions

Literature is sparse on the management of post–pyogenic infection kyphosis in immunocompromised patients. The current case shows that aggressive correction techniques such as pedicle subtraction osteotomy can be performed in such cases but within a multidisciplinary team to deal simultaneously with the different issues of the fragile patient.