Friday, September 14, 2007

Anterior/Posterior L5S1 Reconstruction for L5S1 Discitis likely secondary to Dental Infection. Sep 13 2007 Hey Clinic Surgery

Wednesday at Hey Clinic we saw Nell, from New Bern in Clinic.  She had been doing well after multilevel instrumentation and fusion.  However, over the past couple of months, she developed severe lower back pain and difficulty walking.  Her Xrays showed some severe degeneration below her previous fusion at L5S1, and her CT scan showed that there was severe destruction of that L5S1 disc space and the adjacent L5 and S1 vertebral bodies, suggesting discitis.  Aspiration of that disc done in New Bern showed no fluid or bacteria.  She had some knee surgery a few months before, but was uneventful.  Later, the family remembered that she had several major abscesses in her jaw about 11 months ago.  This is likely source of bacteria that went through blood to this disc.  Now, she was afebrile, but her ESR and CRP were both elevated, and she was in agony, unable to sit, stand or walk.
My Hey Clinic and hospital staff rearranged my whole schedule for Thursday and Friday to help make room for this woman who was really suffering.
Yesterday, with the help of Dr. Chris Watters who performed the anterior approach, we removed the infected disc anteriorly, washed it out and packed it with bone graft.
I then turned her over and extended her fusion down to the iliac wings bilaterally.
Multiple cultures were sent off.

What can we learn:
Infections from one part of the body can spread through the body to other parts of the body, including the spine and discs.
Preventing infections from getting out of control is key.
Making sure you tell your doctor of all infections you have is very helpful when trying to determine cause of pain, and/or infection elsewhere.

Nell did great with her surgery yesterday. Her surgery was 5 hours, and she was resting comfortably in ICU last evening.
Notice on the X-Ray how I have two transverse cross-connectors, and then a third one parallel to the other rods.  This helps prevent rod breakage.  I also used the new stronger “Blue Rods” from Synthes, which are the latest in titanium alloy.

Many thanks to Sandra and Lawrence, who did wonderful job as scrub techs, and both stayed late.
Many thanks also to Jaclyn, my PA, who stayed late as well to help, and to Brittany who helped to get Nell admitted
Many thanks to Hey Clinic Team who made a next day front/back surgery happen including rearranging many patients.
Many thanks to the patients and their families who were willing to move their appointment so that Nell could get out of agony.

Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC USA

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