Case Study: Spine Infection
HISTORY
- 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.
PHYSICAL EXAM
- She had severe lumbar spasms forcing her to walk with a cane, stooping forward.
PREOPERATIVE IMAGING
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).
DIAGNOSIS
- Lumbar osteodiscitis (infection of the vertebral bodies and disc) with expanding epidural phlegmon (infection spreading into the spinal canal)
SURGERY
- 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
POSTOPERATIVE IMAGING
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.
OUTCOMES
- 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.
Hospital Affiliations
Mt. Sinai
Saint Barnabas Medical Center
Lenox Hill
Formerly St. Luke’s-Roosevelt
Hospital in Manhattan
Livingston, NJ
Formerly Lenox Hill Hospital
in Manhattan
Outpatient Surgery Centers
Malo Surgery Center
201 Route 17 North 12th floor
Rutherford, NJ 07070
Phone: 201-549-8890
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Midtown Surgery Center
305 East 47th St.
New York, NY 10017
Phone: 212-751-2100
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Advanced Spine Surgery Center
855 Lehigh Ave,
Union, NJ 07083
Phone: 908-557-9420
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Denville Surgery Center LLC
3130 Route 10 West
Denville, NJ 07834
Phone: 973-328-3475
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