Case Study: Spine Infection
- The patient is a 51-year-old, HIV+ female with severe low back pain due to infection. She was on chronic antibiotics with no improvement of her symptoms.
- She had severe lumbar spasms forcing her to walk with a cane, stooping forward.
Sagittal MRI sections showing L3-L4 osteodiscitis (infection of disc and surrounding bone) with erosion of the endplates and disc collapse, with expanding epidural phlegmon (collection of infection putting pressure in the nerves of the spinal canal).
- Lumbar osteodiscitis (infection of the vertebral bodies and disc) with expanding epidural phlegmon (infection spreading into the spinal canal)
- MIS (minimally invasive surgery) XLIF (extreme lateral interbody fusion) and posterior fusion with percutaneous pedicle screws placed between muscle planes.
- 1 hour of operative time
- 20 cc blood loss
AP and lateral Xrays showing interbody cage placed through a lateral tubular retractor after debridement of the infected disc and bone, and placement of unilateral pedicle screws placed between muscle planes. The interbody cage provides enough stability that only unilateral screws are necessary in this one level fusion, reducing operative time and pain.
- The patient was in the hospital for one day for pain control.
- She went home the following morning on oral pain medications with improved back pain.
- In a patient with her characteristics (HIV+, spinal infection), MIS surgery was performed with less pain and less tissue dissection, minimizing the risks of wound breakdown and surgical site infection.
- Six weeks after surgery, the patient was ambulating with an upright posture and no back pain.
- Six months after surgery, her infectious disease specialist stopped her antibiotics as her infection had resolved.
Saint Barnabas Medical Center
Formerly St. Luke’s-Roosevelt
Hospital in Manhattan
Formerly Lenox Hill Hospital