Hardware infection after a spine surgery: a case report
The present case has been reported in the journal Applied Radiology. A 70-year-old man underwent a T9-T10 facetectomy with instrumented back fusion. Postoperatively, he developed a bowel obstruction and was found to have a rectal squamous cell carcinoma. Emergency resection was performed followed by chemoradiation.

A follow-up PET/CT was obtained 4 months’ status post-resection, which demonstrated suspicious uptake around the thoracic spine hardware. The ordering physician was notified of a potential hardware infection, but at that time, the patient was asymptomatic and had been recently seen in clinic without any evidence to suggest infection.

Within 1 week following the PET/CT, the patient presented with a new abscess and drainage from his incision site. Erythrocyte sedimentation rate and C-reactive protein were both elevated. Cultures from the abscess grew methicillin-resistant Staphylococcus aureus. The patient was taken back to the OR for debridement and hardware removal. He eventually made a full recovery after a prolonged course of antibiotics.

On a 4-month follow up PET/CT, evaluation of the contrast-enhanced CT was limited due to artifacts from hardware. Fused PET/CT (C, D) and standard attenuation-corrected (AC) PET images (E,F) demonstrated increased FDG uptake in paraspinal muscles and central canal around the T9-T10 hardware as well as increased uptake in the left 10th costovertebral joint.

Careful review of the non-attenuation corrected (NAC) images (G, H) demonstrated persistent uptake in these areas consistent with a pathologic process. A dedicated CT scan (Figure 2) demonstrated new erosive changes in the head of the left 10th rib (A, arrow) and subtle edematous changes in the paraspinal muscles and posterior soft tissues at the T9-T10 level (B, oval). He underwent emergency removal of the hardware and was treated with a 9-week course of IV antibiotics.

The final diagnosis was Hardware infection.

The primary differential includes metastasis from known colorectal cancer, primary malignancy, or infection. Colorectal metastasis is least likely in the spine and synchronous primary is also least likely in surgical bed. Given the patient’s recent surgical history, the patient’s primary physician and oncologist were notified of a likely hardware infection.

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