Osteomyelitis and Discitis from C. Acnes Infection After Vertebral Augment Procedure: A Case Report

Case Diagnosis: An 83-year-old man with a history of back pain required surgical intervention after C. Acnes infection of SpineJack vertebral augment procedure.

Case Description or Program Description: The patient developed severe, low right-sided back pain, open MRI demonstrated acute L1 and L4 vertebral body fractures. He subsequently underwent SpineJack and cement vertebral body augmentation at L1 with 50 mm bilateral implants and balloon-assisted kyphophasty at L4. One week later, the patient reported unremitting,10/10 lower right back pain and was prescribed oxycodone. Two months later, a repeat open MRI reported a burst fracture at T12 with the dorsal margin extending into the spinal canal at T12-L1, caudally to mid-L2. The patient was admitted to the hospital a week later, and a closed-bore MRI reported edema enhancement with cement extending into the disc space at T12-L1 and inferior endplate of T12, concerning for osteomyelitis and discitis. An interventional radiology vertebral body biopsy was performed, and cultures identified Cutibacterium acnes (C. acnes), a slow-growing gram-positive bacteria with biofilm formation that commonly inhabits the skin. Subsequently, the infected SpineJack implant and cement were removed, and an extreme lateral body fusion and corpectomy at L1 was performed. Two days later, a posterior minimally invasive fusion from T12 to L2 was carried out. The patient was educated on skin care management, fall risk safety, urinary incontinence, and pain management before being discharged two weeks later with a 6-week course of ceftriaxone.

Setting: Multi-specialty private practice.

Assessment/Results: At 6 months post-discharge, the patient takes cifran 500 mg twice daily indefinitely for retained hardware and receives blood work every 6 months. He reports no further complications.

Discussion (relevance): This is the first reported case, to our knowledge, of a SpineJack infection with C. acnes requiring surgical intervention and infectious disease treatment.

Conclusions: Interventionists may consider prophylactic antibiotics in the perioperative setting prior to vertebral body augmentation procedures.