History:
A 62-year-old gentleman sought medical attention for low back pain that had persisted for five to six months and significantly worsened over the past month. He also experienced tingling and numbness in both legs, along with difficulty walking due to weakness. The pain, which caused instability in his lower back during movements like getting up or turning in bed, severely affected his sleep quality over the past month. Considering his symptoms and medical background, spinal infection was suspected. The patient has chronic kidney disease and has been undergoing dialysis twice a week for the past one and a half years — a condition that increases the risk of spinal infections. Early diagnosis allowed doctors to initiate spinal infection treatment, addressing both the source of pain and the underlying infection. Timely spinal infection treatment proved critical in managing his condition and preventing further complications.
O/E OF SPINE-
Gait: Pain prevented assessment.
Heel/Toe walk: Pain prevented assessment.
Range of Motion (ROM): Pain prevented assessment.
Diagnosis and Underlying Cause:
Doctors suspected a spinal infection (infective discitis) due to the patient’s ongoing dialysis and repeated vascular access via an arteriovenous fistula. Dialysis patients are at a high risk of bacteremia, which can lead to infections at distant sites, including the spine. MRI confirmed infective discitis at L3-L4, with the infection extending to the L4-S1 region.
MRI:
Condition on Discharge:
- The patient remained stable after surgery and was transferred to his room.
- Subsequent dressings showed that the suture line was dry and clean, with no active discharge.
- The patient did not experience fever or chills during the immediate post-op period.
- On the second day after surgery, he began ambulating with walker support.
- He returned for a follow-up visit 15 days post-surgery for suture removal. The wound appeared healthy, and the sutures were successfully removed.
- After 15 days, the patient no longer needed walker support and could walk independently.
- He was able to climb stairs up and down on day 15 after surgery.
- As this was a case of spinal infection, the patient received long-term antibiotics.
- The patient adhered to the prescribed antibiotics and participated in aggressive physiotherapy, both of which contributed to the best possible recovery results.
Outcome:
Two years post-surgery, Mr. Shivatare is now pain-free, independent, and fully functional. He has resumed his job and performs all daily activities without any restrictions.