Vancomycin resistant Enterococcus faecium (VRE) vertebral osteomyelitis after uneventful spinal surgery: A case report and literature review Carlo Gulì,

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Vancomycin resistant Enterococcus faecium (VRE) vertebral osteomyelitis after uneventful spinal surgery: A case report and literature review Carlo Gulì, Domenico Gerardo Iacopino, Paola Di Carlo, Claudia Colomba, Antonio Cascio, Anna Giammanco, Francesca Graziano, Rosario Maugeri Interdisciplinary Neurosurgery: Advanced Techniques and Case Management Volume 7, Pages 12-16 (March 2017) DOI: 10.1016/j.inat.2016.11.002 Copyright © 2016 The Authors Terms and Conditions

Fig. 1 Pre-operative lumbar MRI. A. Sagittal view. A diffuse spondyloarthrosis, with herniated discs in L3–L4 and microinstability at L4–L5 is documented. B Axial view. The L3–L4 level is depicted. Interdisciplinary Neurosurgery: Advanced Techniques and Case Management 2017 7, 12-16DOI: (10.1016/j.inat.2016.11.002) Copyright © 2016 The Authors Terms and Conditions

Fig. 2 Post-operative lumbar CT scan. Pedicle screws in L3, L4 and L5 bilaterally and intersomatic L4–L5 cage by TLIF. Interdisciplinary Neurosurgery: Advanced Techniques and Case Management 2017 7, 12-16DOI: (10.1016/j.inat.2016.11.002) Copyright © 2016 The Authors Terms and Conditions

Fig. 3 A–B: Post operative CT scan (8months). An area of bone remodeling in both L4 and L5 somatic cortical profiles (orange arrow) is depicted C–D Post operative lumbar MRI scan. C. T2 weighted sagittal images. D. T1 weighted, post contrast MRI. Lumbar enhanced MRI scan revealed a pathological enhancement in vertebral bodies of L4, L5, vertebral canal and paravertebral L3–L5 region. All these findings were suggestive of surgical site infection. Interdisciplinary Neurosurgery: Advanced Techniques and Case Management 2017 7, 12-16DOI: (10.1016/j.inat.2016.11.002) Copyright © 2016 The Authors Terms and Conditions

Fig. 4 Post-medical treatment lumbar MRI. Six months after anti-infective treatment, MRI showed a progressive resolution of infection. Interdisciplinary Neurosurgery: Advanced Techniques and Case Management 2017 7, 12-16DOI: (10.1016/j.inat.2016.11.002) Copyright © 2016 The Authors Terms and Conditions