Virginia Research Day 2021

Bad to the Tailbone: Osteomyelitis as a Result of Sacral Colpopexy Madeline Kirby MD, Jim Wong MD Virginia Tech Carilion School of Medicine Department of Internal Medicine

Objectives

Background Case Presentation

Discussion

• 54 year old woman underwent robotic assisted hysterectomy and sacral colpopexy with use of synthetic mesh • 1 month later she presented to her surgeon complaining of “tailbone” pain • CT scan of her abdomen/pelvis demonstrated stranding in the prevertebral lumbosacral area • She presented 2 months later with worsening radiating pain down her left leg • MRI L spine demonstrated abnormal disc signal and endplate irregularities of L5-S1 concerning for osteomyelitis and discitis. • L5-S1 corresponded to the level at which the sacral colpopexy was performed • L5 endplate biopsy grew E coli and surgical pathology demonstrated chronic osteomyelitis • She underwent removal of the vaginal mesh with disc space debridement and washout • Cultures of the mesh also grew E coli • Patient completed 6 weeks of oral Levofloxacin after debridement

•Later in patient’s course, CT abdomen/pelvis demonstrated a pelvic abscess with direct communication to L5-S1, which further explains the link between the initial surgery and osteomyelitis • Osteomyelitis is a very uncommon complication following sacral colpopexy • Providers should recognize that new or worsening back pain could indicate this surgical complication • Clinicians should maintain a heightened sense of awareness of this diagnosis especially when seeing patients with a history of sacral colpopexy • Timely diagnosis is essential to preventing development of chronic osteomyelitis

• Recognize the potential infectious complication following sacral colpopexy • Reinforce the need for timely diagnosis of osteomyelitis

Introduction

• Lumbosacral osteomyelitis is a rare complication of sacral colpopexy, a procedure used to correct pelvic floor prolapse • There are minimal case reports describing this surgical complication and research is limited • Osteomyelitis requires long term antibiotic usage with possible return to the OR and greatly increases morbidity associated with this surgery

References

1. Api M, Kayatas S, Boza A. Spondylodiscitis following sacral colpopexy procedure: is it an infection or graft rejection? Eur J Obstet Gynecol Reprod Biol. 2015 Nov;194:43-8. doi: 10.1016/j.ejogrb.2015.08.003. Epub 2015 Aug 21. PMID: 26321411. 2. Qu DC, Chen HB, Yang MM, Zhou HG. Management of lumbar spondylodiscitis developing after laparoscopic sacrohysteropexy with a mesh: A case report and review of the literature. Medicine (Baltimore). 2019 Dec;98(49):e18252. doi:10.1097/MD.0000000000018252.PMID:31804356;PMCID:PMC6919408 3. Jensen MDAV, Scranton R, Antosh DD, Simpson RK. Lumbosacral Osteomyelitis and Discitis with Phlegmom Following Laparoscopic Sacral Colpopexy. Cureus .2016;8(7):e671. Published 2016 July 5. doi:10.7759/cureus.671

57

2 0 2 1 R e s e a r c h R e c o g n i t i o n D a y