Psoriasis complicating wound healing after minimally invasive lumbar spinal fusion

Abstract

Postoperative infections after spine surgery can be frustrating for the patient and the surgeon. Particularly, in a patient with psoriasis, the altered genetic and cellular defense mechanisms result in a higher risk of infection that can be difficult to manage. We encountered a 55-year-old woman with multiple plaque psoriasis and psoriatic arthropathy for 15 years, who underwent L4-S1 navigation-assisted minimally invasive fusion procedure for symptomatic lumbar spondylosis while under perioperative systemic antipsoriatic medications. During the early postoperative period, blistering and operative site infection complicated the wound-healing process. The patient developed what appeared to be a pustular flare of psoriasis with widespread erythema and desquamating plaques over multiple areas. The wounds remained nonhealing with marginal necrosis that demanded repeated debridement procedures. Ultimately, negative-pressure dressing was the only modality that prevented the spread of infection, induced healthy granulation, and enhanced wound contraction. Such an extensive dermatological condition with superadded infection complicating wound healing after spine surgery is rarely reported. These conditions can be difficult to manage and require a multidisciplinary approach involving the surgeon, dermatologist, and infectious disease physician.

Keywords

• negative-pressure wound dressing
• postoperative period
• psoriasis
• spine
• spondylosis