gms | German Medical Science

57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

11. bis 14.05.2006, Essen

Spondylodiscitis after colposacropexy due to vaginal vault – a rare complication

Spondylodiszitis nach Kolposakropexie bei Deszensus genitalis – eine seltene Komplikation

Meeting Abstract

Suche in Medline nach

  • corresponding author T. Schmidt - Klinik für Neurochirurgie der Universität Ulm am Bezirkskrankenhaus Günzburg
  • K. Mohr - Klinik für Neurochirurgie der Universität Ulm am Bezirkskrankenhaus Günzburg
  • H.-P. Richter - Klinik für Neurochirurgie der Universität Ulm am Bezirkskrankenhaus Günzburg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 11.178

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2006/06dgnc395.shtml

Veröffentlicht: 8. Mai 2006

© 2006 Schmidt et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: With an ageing population, increasing numbers of women are presenting with pelvic floor disorders. Vaginal vault and descent account to the most common clinical picture in gynecology. Accepted riskfactors are multiparity, menopause, chronic lungs disease, obesity, smoking, weak physical activity and previous hysterectomy. There are many techniques reported to correct this pelvic disease, where the diversity of materials of fixation is varied, including natural material as the abdominal fascia and aponeurosis of rectus muscle.

Methods: A 74-year-old woman was treated by abdominal hysterectomy, bilateral adnexectomy, colposacropexy and Burch colposuspension combined with lateral repair and levator-plasty due to extensive pelvic organ prolapse. At six months after surgery she presented to the hospital with persistent intense back pain, mild fever and incomplete paresis of the left lower extremity. Laboratory data were remarkable for elevated erythrocyte sedimentation rate and C-reactive protein.

Results: Lumbar MRI demonstrated the presence of an epidural abscess, a disk infection at the level L5/S1 and a vertebral osteomyelitis. A computerized tomography-guided biopsy confirmed the diagnosis of spondylodicitis. The patient was treated with surgical debridement, epidural decompression and was stabilized by posterior lumbar interbody fusion. Intraoperatively a prolene mesh was removed from the retroperitoneal space. Postoperatively a mild vaginal bleeding was recognized originating form the vaginal stump. Pelvic sonography and MRI revealed a small lesion corresponding to remnants of the prolene mesh. Surgical cultures identified a polymicrobial infection representing a vaginal flora. During the ensuing 3 weeks, her clinical conditions improved and the laboratory data decreased continuously under antibiotic treatment. Finally, she could be discharged with mild residual motor deficit.

Conclusions: Spondylodictis following abdominal-vaginal sacropexy is an uncommon complication. Our patient developed spondylodiscitis postoperatively, with the suspected route of infection attributed to contiguous spread from an infected prolene mesh. There are only some reports in the literature that describe inflammatory complications according to the lumbar spinal region due to colposacropexy. Both antibiotics and surgical debridement should be considered in the treatment which requires an interdiciplinary approach depending on clinical presentation and the occurrence of neurological deficit.