[Maur]

#30450

Dear Dr. Corenman,

32 years old healthy and active male. A month ago went through an L5-S1 microdisectomy. The same day went home and did two days of antibiotics. I was very swollen and my left leg was hurting a little bit (the same that gave me pain before surgery), so I was taking 2 x 600mg Ibuprofen a day.

Two weeks postop, the Dr removed my stitches, and the wound started leaking some transparent-yellowish and a bit pink liquid; I understand this a seroma.
That leaking continued for about four days. At which point the Dr decided to do a debridement of the zone (the wound was swollen but not red, not fever, not pain).
Samples were taken and in the innermost they found I had a non-resistant strain of Staphylococcus aureus.
Been on antibiotics since that procedure (12 days ago), but my wound continues leaking a lot; and the pain in my leg post debridement is somewhat worst than post initial surgery, now taking 3 x 50mg Diclofenac per day.

Stitches were removed, is a matter of time before my wound stops leaking and closes definitively? Or should I be concerned about it? The wound is a bit open and swollen right now (there’s not pain nor redness).

I understand that my leg pain is associated with a seroma pushing the nerve. Should I do something about this or just wait? Or maybe some kind of excersises?

Thank you very much in advance Doc.

Mauricio

[Donald Corenman, MD, DC]

#30451

You almost immediately developed an infection after the microdiscectomy and the “seroma” is typical fluid that develops from an infection. You have a staphylococcus methycillin sensitive organism which is good as it is easier to cure with IV antibiotics. I want to make sure you have no headaches as a dural leak can accompany this infection. With continued “leaking”, upright headaches and “neck stiffness” are signs of a dural leak.

You should be followed with three factors to determine your healing; the incision stopping draining with your incision healing on its own, feeling better (called improving constitutional signs), and your labs correcting (these are called ESR, CRP and WBC counts). If you are still leaking now 12 days since start of antibiotics and a total of almost a month since surgery, I worry that you have the wrong antibiotics, you need another debridement, you have developed discitis (infection of the disc space with possible osteomyelitis) you have a dural leak or you are not on IV antibiotics but on oral antibiotics (not enough antibiotic exposure for this infection).

You probably do not have a seroma pressing on the nerve as your drainage is the way the body drains excess fluid but you need to read everything above and make sure your surgeon is following correct protocol.

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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