Search

Case report.To report a case of very delayed repeated meningitis after surgical treatment of scoliosis.Delayed infection after spine surgery is a well-reported phenomenon, presenting usually with local wound symptoms and back pain. The occurrence of meningitis after spinal instrumentation is reported but not common. Delayed repeated episodes of meningitis after surgical treatment of scoliosis have never been reported.We report a case of a 44-year-old gentleman, submitted to surgical treatment of scoliosis years ago, who presented with repeated episodes of meningitis due to the formation of an abnormal communication between an infected cyst in the bone cavity where the rods were located and the intradural space in the lumbar spine. Computerized tomography and magnetic resonance imaging revealed the presence of a bone cyst with thickened layering, and surgical exploration revealed the communication between this cystic cavity and the intradural space. After surgical closure of the dural space and cleaning of the cyst, the patient responded well to antibiotic therapy and was free of new episodes of meningitis up to the last follow-up, 1 year after the surgical treatment. Clinical diagnosis of delayed postoperative infection in spine surgery may be difficult if no wound signs are present. Clinical symptoms vary and may include increased back pain, wound redness, swelling and drainage, elevated erythrocyte sedimentation rate and white blood count, fever, and malaise.Delayed meningitis can be a late complication of spinal instrumentation for scoliosis. A high index of suspicion is necessary.

Background: For patients and family members, access to timely specialty medical care for emergent spinal conditions is a significant stressor to an already serious condition. Timing to surgical care for emergent spinal conditions such as spinal trauma is an important predictor of outcome. However, few studies have explored ethnographically the views of surgeons and other key stakeholders on issues related to patient access and care for emergent spine conditions. The primary study objective was to determine the challenges to the provision of timely care as well as to identify areas of opportunities to enhance care delivery.\ud \ud Methods: An ethnographic study of key administrative and clinical care providers involved in the triage and care of patients referred through CritiCall Ontario was undertaken utilizing standard methods of qualitative inquiry. This comprised 21 interviews with people involved in varying capacities with the provision of emergent spinal care, as well as qualitative observations on an orthopaedic/neurosurgical ward, in operating theatres, and at CritiCall Ontario’s call centre.\ud \ud Results: Several themes were identified and organized into categories that range from inter-professional collaboration through to issues of hospital-level resources and the role of relationships between hospitals and external organizations at the provincial level. Underlying many of these issues is the nature of the medically complex emergent spine patient and the scientific evidentiary base upon which best practice care is delivered. Through the implementation of knowledge translation strategies facilitated from this research, a reduction of patient transfers out of province was observed in the one-year period following program implementation.\ud \ud Conclusions: Our findings suggest that competing priorities at both the hospital and provincial level create challenges in the delivery of spinal care. Key stakeholders recognized spinal care as aligning with multiple priorities such as emergent/critical care, medical through surgical, acute through rehabilitative, disease-based (i.e. trauma, cancer), and wait times initiatives. However, despite newly implemented strategies, there continues to be increasing trends over time in the number of spinal CritiCall Ontario referrals. This reinforces the need for ongoing inter-professional efforts in care delivery that take into account the institutional contexts that may constrain individual or team efforts.