[Jshenton]

#26935

Hello Dr Coleman,
I’m hoping you can assist me. I appreciate you are so busy.
My disc damage relates to the LHS of my spine.
In Jan 2017 I had a disectomy to remove a 2.5cm disc rupture that was crushing my sciatic nerve. I presented with agony in the leg, burning sensation, numbness in toes – all the classic signs.
In May 2017 it was discovered the surgery was not a success and I had another rupture. I had a repeat surgery to remove 1.5 cm was conducted. But late June/early July I begun to feel unwell. One morning I awoke to discover I could not move my hips and was walking in a kind of ‘S’ shape. A week later osteomilitis of L5 was diagnosed (no soft tissue infection was discovered)
I was hooked up to a PICC line for 3 weeks followed by 4 weeks of oral antibiotics. I felt amazing while I was on the antibiotics. My back pain, leg pain and nerve pain was zero. It was incredible!
Approximately 4-5 weeks ago I was required to have a gallium scan and MRI with contrast to ensure no residue from the infection and that the discs were still ok. All of this came back fine, although from L1 through to S1 I have tiny little bumps in the discs which, at 38, is normal I’m lead to believe.
However something has gone wrong. The last 3 weeks have been incredibly busy and I have been pushing my body by very hard. However, I have had a return of pain in the buttock at the sciatic point (feels muscular), some pressure burning in the back of the thigh upon sitting and the feeling in the toes comes and goes from being active to being numb.
I have done nothing of note that I would see as having caused something to ‘pop’ however your opinion would be greatly appreciated. After my bout of osteomilits I cannot undergo surgery again because of the risk of re-infection. I also just really don’t want to have to have anything else done this year!
I truly value your opinion and hope you have time to reply.
Many kindest thanks
Jennie

[Donald Corenman, MD, DC]

#26938

So you had 2 microdiscectomies at low lumbar (you don’t identify a specific level-the “L5” level could be L4-5 or L5-S1). You then developed osteomyelitis which is uncommon but rarely occurs. Normally, to treat osteomyelitis, it takes identifying the organism (normally through blood cultures or a direct biopsy) and then 6 weeks of IV and 6 weeks or oral antibiotics specific to the identified organism. The way to determine treatment success is with lab markers (CRP and ESR) as well as patient symptoms (feeling “well”).

A gallium scan (white blood cells tagged with radioisotope gallium) note no “pooling” in the spine- a good sign of successful treatment.

Your new symptoms (“return of pain in the buttock at the sciatic point (feels muscular), some pressure burning in the back of the thigh upon sitting and the feeling in the toes comes and goes” sounds like a return of radiculopathy. This can occur post-infection by another recurrent herniation, a collapse of the disc space (common post-infection) causing foraminal stenosis or by chronic radiculopathy. It is common (about 50%) post-infection to have a fusion occur at the previously infected level so if that is the case, it also could be from a level above or below.

If your infection is cured, you can undergo another procedure. I would consider a new MRI with gadolinium.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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