Skip to main content

Advertisement

SpringerLink
Log in

Pyogenic spondylodiscitis associated with sacral colpopexy and rectopexy: report of two cases and evaluation of the literature

  • Clinical Opinion
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Pyogenic spondylodiscitis includes a spectrum of spinal infections such as discitis, osteomyelitis, epidural abscess, meningitis, subdural empyema, and spinal cord abscess. This is a rare complication of sacral colpopexy, but can lead to devastating consequences for the patient. We present two cases of pyogenic spondylodiscitis following sacral colpopexy. In addition, we discuss 26 cases of pyogenic spondylodiscitis reported in the literature from 1957 to 2012. Techniques to decrease rates of infection include proper identification of the S1 vertebra, awareness of the suture placement depth at the level of the sacrum and at the vagina, and early treatment of post-operative urinary tract and vaginal infections. Awareness of symptoms, timely diagnosis and multidisciplinary approach to management is essential in preventing long-term complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Nygaard IE, McCreery R, Brubaker L, Connolly A, Cundiff G, Weber AM et al (2004) Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol 104:805–823

    Article  PubMed  Google Scholar 

  2. Brubaker L, Nygaard I, Richter HE, Visco A, Weber AM, Cundiff GW et al (2008) Two-year outcomes after sacrocolpopexy with and without burch to prevent stress urinary incontinence. Obstet Gynecol 112:49–55

    Article  PubMed Central  PubMed  Google Scholar 

  3. Higgs PJ, Chua HL, Smith AR (2005) Long term review of laparoscopic sacrocolpopexy. BJOG 112:1134–1138

    Article  CAS  PubMed  Google Scholar 

  4. Cottle L, Riordan T (2008) Infectious spondylodiscitis. J Infect 56:401–412

    Article  PubMed  Google Scholar 

  5. Maher CM, Feiner B, Baessler K, Glazener CM (2011) Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review. Int Urogynecol J 22:1445–1457

    Article  PubMed  Google Scholar 

  6. Paraiso MF, Walters MD, Rackley RR, Melek S, Hugney C (2005) Laparoscopic and abdominal sacral colpopexies: a comparative cohort study. Am J Obstet Gynecol 192:1752–1758

    Article  PubMed  Google Scholar 

  7. Cheung WY, Luk KD (2012) Pyogenic spondylitis. Int Orthop 36:397–404

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Grimes CL, Tan-Kim J, Garfin SR, Nager CW (2012) Sacral colpopexy followed by refractory Candida albicans osteomyelitis and discitis requiring extensive spinal surgery. Obstet Gynecol 120:464–468

    Article  PubMed  Google Scholar 

  9. Rajamaheswari N, Agarwal S, Seethalakshmi K (2012) Lumbosacral spondylodiscitis: an unusual complication of abdominal sacrocolpopexy. Int Urogynecol J 23:375–377

    Article  CAS  PubMed  Google Scholar 

  10. Collins SA, Tulikangas PK, LaSala CA, Lind LR (2011) Complex sacral abscess 8 years after abdominal sacral colpopexy. Obstet Gynecol 118:451–454

    Article  PubMed  Google Scholar 

  11. Downing KT (2008) Vertebral osteomyelitis and epidural abscess after laparoscopic uterus-preserving cervicosacropexy. J Minim Invasive Gynecol 15:370–372

    Article  PubMed  Google Scholar 

  12. Cranney A, Feibel R, Toye BW, Karsh J (1994) Osteomyelitis subsequent to abdominal-vaginal sacropexy. J Rheumatol 21:1769–1770

    CAS  PubMed  Google Scholar 

  13. Cosson M, Narducci F, Querleu D, Crepin G (2001) Experimental use of laparoscopic material: report of a case of spondylodiscitis after laparoscopic sacropexy with Taker. Ann Chir 126:554–556

    Article  CAS  PubMed  Google Scholar 

  14. Cailleux N, Daragon A, Laine F, Deshayes P, Le Loet X, Duval C (1991) Infectious spondylodiscitis after a cure for genital prolapse. 5 cases. J Gynecol Obstet Biol Reprod (Paris) 20:1074–1078

    CAS  Google Scholar 

  15. Roth TM, Reight I (2012) Laparoscopic mesh explantation and drainage of sacral abscess remote from transvaginal excision of exposed sacral colpopexy mesh. Int Urogynecol J 23:953–955

    Article  PubMed  Google Scholar 

  16. Hart SR, Weiser EB (2004) Abdominal sacral colpopexy mesh erosion resulting in a sinus tract formation and sacral abscess. Obstet Gynecol 103:1037–1040

    Article  PubMed  Google Scholar 

  17. Taylor GB, Moore RD, Miklos JR (2006) Osteomyelitis secondary to sacral colpopexy mesh erosion requiring laminectomy. Obstet Gynecol 107:475–477

    Article  PubMed  Google Scholar 

  18. Muffly TM, Diwadkar GB, Paraiso MF (2010) Lumbosacral osteomyelitis after robot-assisted total laparoscopic hysterectomy and sacral colpopexy. Int Urogynecol J 21:1569–1571

    Article  PubMed  Google Scholar 

  19. Shippey S, Sutter E, Belkoff SM, Gutman R, Chen CC (2012) Sacral mesh pullout strength based on suture location for sacrocolpopexy. Gynecol Obstet Invest 74:116–119

    Article  PubMed  Google Scholar 

  20. Good MM, Abele TA, Balgobin S, Schaffer JI, Slocum P, McIntire D et al (2013) Preventing L5-s1 discitis associated with sacrocolpopexy. Obstet Gynecol 121:285–290

    PubMed  Google Scholar 

  21. Dalwai R, Menon KV, Kumar RJ (2010) Pyogenic diskitis of the L5-S1 disk space following inadvertent placement of a sacrocolpopexy screw. Int J Gynaecol Obstet 111:268–269

    Article  PubMed  Google Scholar 

  22. Kapoor B, Toms A, Hooper P, Fraser AM, Cox CW (2002) Infective lumbar discitis following laparascopic sacrocolpopexy. J R Coll Surg Edinb 47:709–710

    PubMed  Google Scholar 

  23. White AB, Carrick KS, Corton MM, McIntire DD, Word RA, Rahn DD et al (2009) Optimal location and orientation of suture placement in abdominal sacrocolpopexy. Obstet Gynecol 113:1098–1103

    PubMed  Google Scholar 

  24. Osmundsen BC, Clark A, Goldsmith C, Adams K, Denman MA, Edwards R et al (2012) Mesh erosion in robotic sacrocolpopexy. Female Pelvic Med Reconstr Surg 18:86–88

    Article  PubMed  Google Scholar 

  25. Tan-Kim J, Menefee SA, Luber KM, Nager CW, Lukacz ES (2011) Prevalence and risk factors for mesh erosion after laparoscopic-assisted sacrocolpopexy. Int Urogynecol J 22:205–212

    Article  PubMed Central  PubMed  Google Scholar 

  26. Bensinger G, Lind L, Lesser M, Guess M, Winkler HA (2005) Abdominal sacral suspensions: analysis of complications using permanent mesh. Am J Obstet Gynecol 193:2094–2098

    Article  PubMed  Google Scholar 

  27. Brizzolara S, Pillai-Allen A (2003) Risk of mesh erosion with sacral colpopexy and concurrent hysterectomy. Obstet Gynecol 102:306–310

    Article  PubMed Central  PubMed  Google Scholar 

  28. Cundiff GW, Varner E, Visco AG, Zyczynski HM, Nager CW, Norton PA et al (2008) Risk factors for mesh/suture erosion following sacral colpopexy. Am J Obstet Gynecol 199:688.e1–688.e5

    Article  Google Scholar 

  29. Gouliouris T, Aliyu SH, Brown NM (2010) Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother 65 [Suppl 3]:iii11–iii24

    CAS  PubMed  Google Scholar 

  30. Voelker A, Hoeckel M, Heyde CE (2012) Lumbosacral spondylodiscitis after sacral colpopexy of a sigmoid neovagina in a patient with vaginal melanoma. Surg Infect (Larchmt) 13(2):134–135

    Google Scholar 

  31. Draaisma WA, van Eijck MM, Vos J, Consten EC (2011) Lumbar discitis after laparoscopic ventral rectopexy for rectal prolapse. Int J Colorectal Dis 26(2):255–256

    Article  PubMed  Google Scholar 

  32. Nosseir SB, Kim YH, Lind LR, Winkler HA (2010) Sacral osteomyelitis after robotically assisted laparoscopic sacral colpopexy. Obstet Gynecol 116 [Suppl 2]:513–515

    Article  PubMed  Google Scholar 

  33. Salman MM, Hancock AL, Hussein AA, Hartwell R (2003) Lumbosacral spondylodiscitis: an unreported complication of sacrocolpopexy using mesh. BJOG 110(5):537–538

    Google Scholar 

  34. Beloosesky Y, Grinblat J, Dekel A, Rabinerson D (2002) Vertebral osteomyelitis after abdominal colposacropexy. Acta Obstet Gynecol Scand 81(6):567–568

    Article  PubMed  Google Scholar 

  35. Weinder AC, Cundiff GW, Harris RL, Addison WA (1997) Sacral osteomyelitis: an unusual complication of abdominal sacral colpopexy. Obstet Gynecol 90(4 Pt 2):689–691

    Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Crozer-Chester Medical Center, Upland, PA, USA

    Katie Propst

  2. Division of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic, Cleveland, USA

    Elena Tunitsky-Bitton & Beri Ridgeway

  3. Department of Obstetrics and Gynecology, Division of Gynecology, University of Michigan, Ann Arbor, MI, USA

    Megan O. Schimpf

Authors
  1. Katie Propst
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elena Tunitsky-Bitton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Megan O. Schimpf
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Beri Ridgeway
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elena Tunitsky-Bitton.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Propst, K., Tunitsky-Bitton, E., Schimpf, M.O. et al. Pyogenic spondylodiscitis associated with sacral colpopexy and rectopexy: report of two cases and evaluation of the literature. Int Urogynecol J 25, 21–31 (2014). https://doi.org/10.1007/s00192-013-2138-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-013-2138-3

Keywords

Search

Navigation