• In Ho Han, Byung Kwan Choi, Kyoung Hyup Nam, and Shine Young Kim.
• Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
• Spine. 2013 Apr 1;38(7):E431-5.

Study DesignA case report of anaerobic vertebral osteomyelitis after percutaneous epidural adhesiolysis.ObjectiveTo present a case of Bacteroides fragilis spondylodiscitis (BFS) secondary to percutaneous epidural adhesiolysis in a 38-year-old woman without predisposing factors.Summary Of Background DataMost cases of BFS result from hematogenous spread from a perianal abscess or sigmoidoscopy or local spread from an adjacent infection. However, BFS due to direct inoculation after percutaneous epidural adhesiolysis has not been previously reported.MethodsA 38-year-old woman presented with spondylodiscitis at the L4-L5 level 2 weeks after percutaneous epidural adhesiolysis. Despite empirical antibiotherapy, the spondylodiscitis and an epidural abscess became much aggravated. Open biopsy and curettage was performed, and metronidazole sensitive Bacteroides fragilis was identified by tissue culture.ResultsMetronidazole was administrated for 5 weeks and symptoms were completely resolved. Follow-up magnetic resonance imaging showed that the spondylodiscitis was completely cured.ConclusionThis is the first report to be issued regarding BFS secondary to percutaneous epidural adhesiolysis. In our case, the pathogenesis may have been direct inoculation of Bacteroides fragilis into the epidural space and disc during percutaneous epidural adhesiolysis because the procedural approach used was adjacent to the anus.

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