A Chronic Post-Surgical Infectious Lumbar Fistula Providing Protection against Imminent Morbidity: A Case Report and Literature Review

Vertebral osteomyelitis (VOM) and spinal epidural abscesses (SEA) are rare infections on the spinal column, more prominently seen in intravenous drug users, diabetics and the immunosuppressed. We report an extremely rare case of a patient with a chronic history of lumbar post-surgical cutaneo-spinal fistulous infection that was unresponsive to conventional antibiotic therapy and ultimately required surgical debridement and spinal re-instrumentation. The novelty of this case was the chronic nature of the patient’s condition that was made possible only by a fortunate post-surgical cutaneo-spinal fistula that withdrew infected particles away from the neurological structures and thus prevented imminent compressive and neurological deficits, and possible eventual death. This rare case highlights the need for prompt surgical evaluation and intervention in patients with progressive VOM or SEA with associated cutaneo-spinal fistulas, especially in cases where conventional antibiotic treatments have failed. We highly recommend a low threshold for surgical debridement and hardware removal with re-instrumentation as appropriate before a spinal compressive emergency arises and/or sepsis develops.