Recurrent Meningitis Secondary to Infection after Spinal Arthrodesis with Instrumentation. A Case Report*

Postoperative wound infection is a well recognized complication of the operative treatment of adolescent idiopathic scoliosis. The prevalence of this complication varies, but it has been reported to be as high as 7.5 per cent (thirty-seven of 493 patients)2. The signs of postoperative infection (persistent fever, pain, swelling of the wound, erythema, and drainage) usually appear relatively early. Recently, however, Richards reported on ten patients who had a delayed infection at an average of twenty-five months after an operation for the treatment of scoliosis. Low-virulence organisms frequently grew on culture of specimens taken from deep within the wound, and four of the infections were thought to have originated at the time of the operation rather than as a result of hematogenous seeding of the area around the implant. I present the case of a patient who had recurrent episodes of meningitis secondary to a late postoperative wound infection that developed eleven months after spinal arthrodesis and instrumentation for the treatment of adolescent idiopathic scoliosis. A fourteen-year-old girl was seen because of adolescent idiopathic scoliosis with a right thoracic curve of 54 degrees (Fig. 1). A review of previous radiographs revealed that the curve had been 47 degrees four months earlier. Fig. 1 Preoperative posteroanterior radiograph of the spine of a fourteen-year-old girl who had adolescent idiopathic scoliosis, showing a right thoracic curve of 54 degrees. Radiographs of the pelvis demonstrated incomplete excursion (ossification) of the iliac apophysis. Because the patient had growth remaining and had had recent progression of the curve, operative treatment was recommended. The patient was managed with posterior arthrodesis and instrumentation from the fourth thoracic to the second lumbar vertebra. The postoperative course was benign, and the patient was discharged four days after the operation. Eleven months postoperatively, the patient began to have episodes of …