Introduction: Spondylodiscitis is a rare complication of sacral colpopexy (SC) for the treatment of pelvic organ prolapse. Characterized by inflammation of the vertebral body and intervertebral disc, spondylodiscitis is associated with severe consequences including prolonged immobilization and permanent disability. Several cases have described this complication with most patients presenting within 5 months of SC. Here, we present a rare case of spondylodiscitis in a patient with a remote (>20 year) history of SC.
Methods: An 82-year-old woman with a history of T2DM, CKD-S3, and HFpEF presented to the ED after 2-weeks of increasing back pain, a 10-day history of inability to ambulate, and 4-month history of vaginal discharge.
Results: Lumbar MRI revealed an enhancing tract from the vaginal cuff to the L5-S1 disc space and spondylodiscitis at L5-S1. On further questioning the patient endorsed a SC over 20 years prior. Based on shared decision making, non-operative treatment was pursued. Biopsy from the L5 vertebrae and L5-S1 disc space grew no organisms, but blood cultures grew Abiotrophia defectiva and Actinomyces naeslundii. She was discharged on a 6-week course of IV Unasyn. Following treatment, the patient remained non-ambulatory, and repeat imaging showed continued osseous involvement with a new pathologic fracture of the S1 vertebrae. Repeating biopsy again showed no growth. Due to persistent worsening of radiographic findings the decision was made to continue treatment with IV Daptomycin and Ceftriaxone for 6 weeks. Lumbar MRI at the end of treatment showed no further progression. The patient unfortunately was still non-ambulatory.
Conclusion : Spondylodiscitis following SC has only been reported in case reports. Common risk factors include inadvertent placement of bone anchors into the L5-S1 disc space and the use of surgical mesh. Recent literature has supported the idea of mesh rejection in the development of spondylodiscitis, particularly in cases where no microorganisms can be isolated. Due to the decision to pursue non-operative treatment, mesh rejection cannot be ruled out as a potential cause. While all previously reported cases of spondylodiscitis present within 6 months of SC, the present case rases awareness for the risk of spondylodiscitis decades after SC.
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