Pseudomonas aeruginosa osteitis of the spinal process after peridural anesthesia

BACKGROUND: Osteitis of the posterior wall of the spinal canal is an except ional complication after peridural anesthesia. Prognosis depends on early d iagnosis based on clinical signs and imaging data. CASE REPORT: A 73-year-old man was hospitalized for lower back pain and fev er of 3 weeks duration after a total hip arthroplasty performed under gener al anesthesia. Computed tomography and magnetic resonance imaging of the lu mbar spine disclosed osteitis of the spinal processes Local bacteriology sa mple evidenced Pseudomonas aeruginosa. Outcome was favorable after a 6-mont h treatment. DISCUSSION: Data in the French and English literature (since 1948) on bone infections following epidural anesthesia have included 5 cases of spondylod iscitis and 1 case of posterior wall osteitis. The diagnosis is suggested b y the clinical presentation, Standard x-rays contribute little. Early diagn osis in the infraradiological phase can be obtained with bone scintigraphy. Computed tomography or magnetic resonance imaging are currently highly con tributive to diagnosis and follow-up after treatment. Contamination may be direct or via the blood stream or result from an extension of a neighboring infectious focus. Antibiotic therapy and immobilization are indicated. Rig orous application of strict aseptic procedures during lumbar puncture and u se of the epidural catheter are crucial for prevention.