Lumbar Spine Infection History:
Lumbar Spine Infection was suspected in a 42-year-old gentleman who presented with a severe onset of low back pain, radiating down his right lower limb for the past 15 days. This debilitating pain had left him bedridden and unable to carry out daily activities. Despite prior treatment at another hospital, his symptoms persisted and worsened over time.
The pain intensified with any change in position, such as getting up, sitting down, or turning in bed. Simple tasks like walking or sitting without support became extremely painful, indicating a possible underlying spinal pathology. Alongside these symptoms, the patient reported a persistent fever for the past 5–6 days — a red flag pointing toward Lumbar Spine Infection.
Additionally, he experienced significant weight loss, reduced appetite, and disturbed sleep due to ongoing pain. These systemic symptoms, when combined with the localized back pain and neurological involvement, further supported the diagnosis of Lumbar Spine Infection. The condition had severely impacted his quality of life, even making routine activities like eating difficult, as he refrained from meals to avoid the pain associated with bowel movements.
On examination of Lumbar Spine Infection:
The patient showed midline tenderness over the sine during the examination and was sensitive about being touched on his back. He also had tenderness in the paraspinal muscles. Due to intense pain, he was unable to walk normally, including performing heel and toe walks.
MRI findings confirm lumbar spine infection (spondylodiscitis) at the L5-S1 level:
MRI of the lumbosacral spine with whole spine screening (dated 21/08/23) revealed definitive signs of spondylodiscitis at the L5-S1 level, including endplate destruction, intervertebral disk infection, T2 hyperintensity, and progressive endplate erosion. Contrast-enhanced imaging confirmed these findings, correlating with the patient’s symptoms of severe low back pain, radicular pain, fever, weight loss, appetite loss, and functional decline.
Operations or Special Procedures Performed for Lumbar Spine Infection
The surgery was significant due to its comprehensive approach in managing the patient’s condition. Spinal fusion helped stabilize the spine and alleviate pain, while the use of a bone graft mixed with antibiotics targeted the underlying infection and supported healing. Implant fixation ensured proper spinal alignment during recovery. Additionally, laminectomy and decompression relieved nerve pressure, improving spinal function and reducing radicular symptoms. The procedure was performed by Dr. Sangram Rajale using GESCO Surgicals implants, including poly screws and pre-cut rods commonly used in spinal fusion surgeries.
L5-S1 Posterior Spinal Fusion:
Fusion of the L5 and S1 vertebrae in the lower spine.
Performed to stabilize the spine, reduce pain, and manage spinal infection (spondylodiscitis).
Local Bone Graft with Antibiotics:
Bone graft used to promote healing and achieve solid fusion.
Antibiotics mixed with the graft to control local infection and support recovery.
Fixation with Implants:
Internal fixation using:
Poly screws (6.5 mm)
Pre-cut rods (50 mm)
Implants sourced from GESCO Surgicals.
Purpose: to maintain spinal alignment and support fusion during the healing phase.
Debridement:
Surgical removal of infected and necrotic tissue at the L5-S1 level.
Essential for infection control and to create a suitable environment for healing.
L5 Laminectomy and Decompression:
Removal of part of the lamina at L5 to relieve pressure on neural structures.
Aimed at alleviating radicular pain and improving neurological symptoms.
Condition On Discharge:
- The patient was stable after surgery and moved to the ward.
- There were no fever or chills post-surgery, and the pain relief was significant.
- The patient was very pleased with the pain relief and started walking on day 2 after surgery.
- By day 3, the patient was completely pain-free with minimal incision site discomfort.
- By day 6, the suture line was dry and clean.
- The patient was discharged with IV antibiotics for 6 weeks, which he preferred to take at home.
- The patient was happy to be able to walk soon after surgery, especially after being bedridden for 15 days.
- After about 2 months, the patient returned, completely free of pain, and had resumed working.
- Follow-up X-rays showed good fusion and no signs of infection recurrence.