Methicillin-resistant Staphylococcus aureus meningitis following revision microdiscectomy: a case report.

Healthcare-associated bacterial meningitis is a rare but life-threatening complication of spinal surgery, most commonly associated with incidental durotomy. A 59-year-old man developed fever, altered mental status, and generalized seizures 1week after uncomplicated revision L4-L5 microdiscectomy. Magnetic resonance imaging demonstrated diffuse intracranial and spinal leptomeningeal enhancement with a postoperative lumbar fluid collection. Cerebrospinal fluid (CSF) analysis was consistent with bacterial meningitis. Emergent irrigation and debridement revealed copious purulent fluid without evidence of a CSF leak despite meticulous dural exploration. Wound and CSF cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Following surgical debridement and targeted intravenous vancomycin, the patient achieved substantial neurological recovery and was independently ambulatory with only mild residual cognitive impairment at 6 months. MRSA meningitis may occur after revision lumbar microdiscectomy without a recognized dural tear. Early recognition, surgical source control, and targeted antimicrobial therapy are essential to optimize outcomes.