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European Spine Journal
Published in: European Spine Journal 1/2016

01-05-2016 | Case Report

Use of PET/CT in the early diagnosis of implant related wound infection and avoidance of wound debridement

Authors: Yue Wang, Jason Pui-Yin Cheung, Kenneth Man-Chee Cheung

Published in: European Spine Journal | Special Issue 1/2016

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Abstract

Purpose

Delayed infections after spinal instrumentation typically require complete implant removal and extensive wound debridement due to the difficulties in establishing an early diagnosis. We report a case of occult late infection after posterior spinal instrumentation that was detected early using PET/CT and therefore was successfully treated with antibiotics alone.

Methods

A 26-year-old woman who underwent posterior spinal instrumentation and fusion for scoliosis correction had superficial pseudomonal infection that healed with ceftazidime and levofloxacin and was admitted 4 months later with mild back pain. She had no fever and the surgical wound healed well. Laboratory tests were compatible with late infection but radiographs showed no signs of implant infection. The patient was suspected of having ongoing occult late infection and thus, underwent a PET/CT.

Results

PET/CT revealed a significant pathological FDG uptake at the T5 vertebral body and the area surrounding proximal end of the T5 instrumentation. The maximal standardized uptake value (SUV) was 7.9 for the T5 vertebra and only 2.3 for the patient’s liver, suggesting an infection pathology. A conclusive diagnosis of delayed onset infection after spinal instrumentation was established and the patient was immediately started on oral anti-pseudomonal treatment. The scoliosis correction was well maintained 10 months after the index surgery and she had no signs of implant infection.

Conclusions

PET/CT provides detailed diagnostic information for occult infections in the absence of morphological changes and thus, is valuable for an early diagnosis of late infection after spinal instrumentation. It is possible to retain the instrumentation in the case of late infection, if early detection and efficacious treatment can be achieved timely.
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Metadata
Title
Use of PET/CT in the early diagnosis of implant related wound infection and avoidance of wound debridement
Authors
Yue Wang
Jason Pui-Yin Cheung
Kenneth Man-Chee Cheung
Publication date
01-05-2016
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue Special Issue 1/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-015-4044-5

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