Lumbar Spine Surgery in a Patient With Recent Monkey Bite Receiving Rabies Immunoglobulin: A Case Report on Perioperative Anesthetic Challenges

Rabies is a universally fatal acute zoonotic disease caused by rhabdovirus, and postexposure prophylaxis (PEP) remains the mainstay of prevention. Patients who sustain animal bites may require urgent or elective surgical interventions for unrelated conditions while simultaneously undergoing rabies prophylaxis. The perioperative team often faces uncertainty regarding the safety of anesthesia and surgery in patients receiving rabies vaccines or rabies immunoglobulin (RIG). This report discusses such a scenario in a patient posted for elective lumbar spine surgery. We report the case of a male in his mid-60s with chronic low back pain and bilateral lower limb radiculopathy, with the left side more involved, diagnosed with a prolapsed intervertebral disc at the L5-S1 level with lumbar canal stenosis. Following failed conservative management for six weeks, he was planned for decompression and transforaminal lumbar interbody fusion (TLIF) at the L5-S1 level. On the day before surgery, he received a scratch from a monkey, classified as a Grade III wound, which was managed, and PEP was initiated, including human RIG and a four-dose intradermal vaccine regimen. Surgery was deferred till completion of PEP, following which he underwent TLIF at the L5-S1 level. There were no intraoperative adverse events. The immediate postoperative course was uneventful, with significant symptomatic improvement. The surgical site was found to be healthy on postoperative day 2, and the patient was discharged on the next postoperative day. Our case shows that timely administration of rabies PEP in the form of RIG and vaccine, along with postponement of elective surgery, does not preclude the patient from safely undergoing elective spine surgery in the future, provided vaccination schedules are not interrupted and adequate time is allowed after immunoglobulin administration. In our patient, lumbar TLIF was performed after completion of the PEP schedule, and he had an uneventful intraoperative and postoperative course, with a good clinical recovery. This highlights the importance of appropriate coordination between infectious disease management and individualized surgical planning, along with careful perioperative and postoperative monitoring, to balance the urgency of spinal disease and the need for effective rabies prevention for optimal surgical outcomes.