Infectious Spondylitis Caused by Staphylococcus lugdunensis Following an L-PEN Procedure: A Case Report

We report a rare case of infectious spondylitis caused by Staphylococcus lugdunensis following lumbar percutaneous epidural neuroplasty (L-PEN). A 78-year-old man with chronic low back pain refractory to conservative treatment underwent L-PEN and subsequently developed worsening back and bilateral hip pain 18 days after the procedure, followed by progressive motor weakness. Initial laboratory evaluation revealed markedly elevated inflammatory markers. Contrast-enhanced magnetic resonance imaging demonstrated diffuse multilevel epidural enhancement with vertebral endplate involvement, consistent with infectious spondylitis. Blood cultures grew oxacillin-susceptible Staphylococcus lugdunensis. Empirical intravenous vancomycin was initiated and subsequently de-escalated to targeted β-lactam therapy based on susceptibility results. Despite extensive epidural and paraspinal involvement, no surgically drainable abscess was identified, and the patient was managed conservatively. After a total of 12 weeks of antimicrobial therapy, including intravenous treatment followed by oral step-down therapy, the patient achieved complete clinical and radiological recovery without surgical intervention. This case highlights the pathogenic potential of Staphylococcus lugdunensis in procedure-related spinal infections and underscores the importance of early diagnostic imaging and appropriate microbiological evaluation when pain worsens after spinal interventions.