History:
A 62-year-old gentleman came with complaints of low back pain since five to six months, which had increased over the past one month. He also had a history of tingling and numbness in both legs. There was a history of difficulty in walking due to weakness. The patient reported instability-type pain in his lower back while getting up, sitting down in bed, and turning. He also experienced sleep disturbances due to the pain for the past one month and had not had a sound sleep. Notably, the patient is a case of chronic kidney disease and has been undergoing dialysis twice weekly for the past one and a half years.
O/E OF SPINE-
Gait – could not be assessed due to pain
Heel/Toe walk – could not be assessed due to pain
ROM – could not be assessed due to pain
Diagnosis and Underlying Cause:
Given his ongoing dialysis and the repeated vascular access through an arteriovenous fistula, a spinal infection (infective discitis) was suspected. Such patients are at 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:-
a. Patient stable after the surgery and was shifted to his room.
b. Suture line – dry and clean on subsequent dressings in the hospital , no active discharge was noted
c. No episodes of fever with chills in the immediate post op period.
d. Patient ambulating with walker support On day 2 of his surgery.
e. Patient came for follow up after 15 days for suture removal. The wound okaywas healthy and suture removal was done.
f. Patient was independent Walker that means no need for Walker support to walk after 15 days of surgery.
g. He could climb stairs up and down on day 15.
h. Since this was a case of infection in the spine patient was given long term antibiotics.
i. He was complaint in taking those antibiotics and doing aggressive physiotherapy, which together yielded in the best possible result.
j. 2 years since the surgery patient is extremely happy and is able to perform all his day to day activities along with his job
Outcome:
Now, two years after surgery, Mr. Shivatare is pain-free, independent, and fully functional. He has returned to his job and is able to perform all daily activities without restrictions.