History :
A 38-year-old female from Pune, with a history of L5-S1 discectomy performed 3 months ago at an outside hospital, now presents with severe low back pain radiating to both lower limbs (left more than right), which has worsened over the past month. She reports difficulty in keeping her left sandal on, along with tingling and numbness in the right lower limb. The pain has become so intense that she is unable to walk or even sit. Initially, she underwent surgery by a spine surgeon to address low back pain and right leg pain, and she remained symptom-free for around 3 months. However, over the last 15 days, she has developed sharp, radiating pain in the lower back, now affecting both legs.
Radiology Investigation :
MRI:
The MRI revealed L5-S1 infective spondylodiscitis, an infection involving the intervertebral disc and adjacent vertebrae. This was accompanied by retrolisthesis, where the L5 vertebra has slipped backward over the S1 vertebra.
CT Scan (LS Spine – Plain):
The CT scan confirmed the presence of infective spondylodiscitis at the L5-S1 level, providing detailed visualization of the infection and inflammation affecting the spine. In addition, degenerative changes were observed in the lumbar spine, indicating wear and tear, such as disc degeneration and possible bony changes.
X-ray Lumbosacral Spine (Flexion/Extension):
The X-ray showed osteophytes, or bone spurs, at the levels of LV3, LV4, and LV5, which are signs of chronic degeneration in the spine. There was also a noticeable decrease in the intervertebral space at the LV5-SV1 level, which suggests disc degeneration. Furthermore, the X-ray demonstrated retrolisthesis of the LV5 over SV1 during flexion, confirming instability in this region of the spine during movement.
These findings collectively indicate a combination of infection and degenerative changes contributing to the patient’s symptoms, along with mechanical instability in the lower spine.
Operation :
L5-S1 posterior spinal instrumentation and posterolateral fusion were performed under general anesthesia on December 14, 2021, by Dr. Sangram Rajale.
Implants Used:
Manufacturer: Medtronic (Titanium)
This procedure aimed to stabilize the spine and address the instability caused by the infective spondylodiscitis and degenerative changes at the L5-S1 level.
Condition On Discharge :
After undergoing the L5-S1 posterior spinal instrumentation and posterolateral fusion, the patient exhibited significant and immediate improvements in her condition. The severe low back pain that had previously incapacitated her was greatly alleviated, allowing her to regain full mobility. Remarkably, she was able to walk, climb stairs, sit, and stand with ease and without any discomfort soon after the procedure. The sharp, radiating pain she had experienced in both legs, particularly on the left side, was also substantially reduced, offering her considerable relief.
In addition to her physical recovery, the patient was started on a regimen of long-term antibiotics to effectively combat the underlying infective spondylodiscitis. This measure was essential to ensure the infection was fully controlled and to prevent any recurrence or spread of the infection to adjacent spinal structures. The combination of surgical intervention and medical therapy significantly improved her overall condition, and she was discharged in a stable state, with instructions for follow-up to monitor her progress and the resolution of the infection.