Case Report: A rare but critical complication in patients with lumbar infection combined with cauda equina syndrome—sacrococcygeal pressure sores

TL;DR

A 65-year-old man with a lumbar infection and neurological issues developed a severe pressure sore, which was successfully treated with surgery and infection control.

Contribution

Highlights a rare but critical complication in lumbar infection patients with cauda equina syndrome and emphasizes early prevention of sacrococcygeal ulcers.

Findings

A lumbar spine infection combined with cauda equina syndrome can lead to severe sacrococcygeal pressure sores.

Combined surgical and antimicrobial treatment effectively managed both spinal infection and pressure sore.

Early identification and prevention of pressure sores are crucial in such patients to avoid severe complications.

Abstract

This report presents a complex case of a 65-year-old male patient with a lumbar spine infection (T12-L1) caused by Staphylococcus aureus, leading to cauda equina syndrome, and subsequently developing a massive infectious pressure sore in the sacrococcygeal region. Back pain due to spinal infections, analgesic use, neurological deficits, and systemic infections masked the early signs of the pressure sore. Prolonged immobilization and neurogenic bladder and bowel incontinence led to a 5 cm × 5 cm deep pressure sore in the sacrococcygeal area. Involving a single-stage surgery for debriding the spinal lesion and performing internal fixation, along with debriding the sacrococcygeal ulcer using Vacuum Sealing Drainage (VSD) in both infected areas, this treatment not only aids in infection control but also reduces the overall treatment duration. Through multiple VSD changes, antimicrobial therapy, and nutritional support, the spinal infection was cured, and the pressure sore wound healed. This case underscores the importance of early prevention and identification of sacrococcygeal ulcers in patients with lumbar spine infections and neurological deficits to prevent the occurrence and progression of this severe complication.

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