[NikkiEvans]

#21920

I had osteomyelitis, severe spinal stenosis, had laminectomy 5/15, developed a seroma, haven’t been able to sit up.
Post laminectomy mri:

Showed 2″ seroma pressing on L3-L4, At L4-L5, disc space narrowing, disc bulge, and facet hypertrophy. There is severe bilateral neural foraminal stenosis.
There is postoperative enhancement involving the operative bed from level of L2 through S1. There is also enhancement of the disc spaces at the level of L2-3, L3-L4, and L4-L5. This may be secondary to POST-OP changes or possible discitis could have a similar appearance. Clinical and laboratory correlation suggested. Then my surgeon ordered a 2 month CT scan follow up, but then he retired. They didn’t assign me a new surgeon and have it checked until ordering an x-ray in December, then a CT scan in March…

Yesterday’s MRI results:
There is much improved discitis and osteomyelitis L3-L4 level with normalization of marrow edema. There is a destruction of the disc space with this level with partial compression deformity at L3-L4. Paraspinal granulation tissue is present. There is bilateral facet arthopathy and evidence of posterior decompression. Post contrast images reveal residual enhancement granulation tissue L3-L4 also within the epidural space.
Impression: Much improved discitis and osteomyelitis L3-L4 with paraspinal enhancing granulation tissue.

So, do I still have osteomyelitis and discitis?? Surgeon said I do not, but this sounds like I do…an earlier CT SCAN W/O contrast said I had 65% disc collapsed at L3-L4…I’m not sure how to proceed… My CBC has METAMYELOCYTES and myelocytes, elevated RBC’s abnormal sized RBC’s, elevated NEUTROPHILS, elevated myelocytic bands, elevated METAMYCYTic bands…not sure what exactly is going on, and wondering if I need a second opinion…

[Donald Corenman, MD, DC]

#21924

I assume your osteomyelitis occurred after your spinal decompression and not before. You don’t note that your severe foraminal stenosis was due to this seroma or preexisting narrowing that was not taken care of from surgery.

Was the osteomyelitis “presumed” due to MRI findings or did you have an actual infection (long term IV antibiotics and a “washout” typically called an I&D-irrigation and debridement)? If you did have an infection, what was the organism and what antibiotic did you get placed on?

It certainly seems like you had a true osteomyelitis due to the last MRI report (“There is a destruction of the disc space with this level with partial compression deformity at L3-L4. Paraspinal granulation tissue is present”).

MRIs are slow to show improvement and sometimes look worse when you really are improving. The key markers are four, how you feel (are you getting better-feeling less crappy), CRP, ESR and WBC count. Blood cultures can occasionally be helpful.

It never hurts to get a second opinion if you have some concern for your progress and are not getting answers.

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.

[NikkiEvans]

#21927

Sorry for not clarifying better…osteomyelitis was pre laminectomy, as was severe stenosis. I have Systemic Behçet’s Disease AND CVID, and my spine has been deteriorating since 2003 all on it’s own. I had been getting ESI’s and was going to try stem cell therapy, but had an abscess close to my spine cut open, and infection spread to spine. Had laminectomy because Neurosurgeon said Lumbar Spine had turned to mush…
Antibiotic for 6 weeks…looking now..Meropenem:

Started March 29th 2gm q8h over 3 hours

2. Vancomycin:
Started March 27th – 29th

E-coli in bloodstreem was also septic

Proteus in spine

I haven’t been able to sit up for more than 30 minutes, or stand at all…and now my left leg is having pain in hip and knee since the osteomyelitis occurred, afraid I may still have it and it has spread. CRP normal, sed rate slightly elevated.

[NikkiEvans]

#21930

By the way, THANK YOU SOOOOOOOOO MUCH for the quick and thorough reply. I am a complicated patient, and was hoping for the least invasive alternative, but with the now 65% collapsing disc and destructed endplates at both ends of the laminectomy site, as well as the still stenosed area below the laminectomy, I’m assuming another surgery is imminent…

[Donald Corenman, MD, DC]

#21938

Here is what the internet states about Bechet’s disease and CVID. Behçet’s disease or Silk Road disease, is a rare immune-mediated small-vessel systemic vasculitis that often presents with mucous membrane ulceration and ocular problems.This means that the small blood vessels become inflamed due to an autoimmune condition.

Autoimmune disorders can attack any system depending upon the disorder. In a normal immune response, alien proteins such as those of bacterial or viral origin trigger the immune system to destroy the invading organism. In an autoimmune disorder, the immune system becomes confused and develops sensitivity to normal body proteins. When the immune response mistakenly identifies these normal host proteins as “foreign invaders”, inflammation, swelling, erosion of bone, joint and blood vessel destruction can occur (vasculitis). This is the basis of an autoimmune disorder.

In Bechet’s disorder, the mucous membranes (the inside surfaces that can tolerate continuous moisture) develop “sores” or erosions. This disorder can also affect the eyes and the intestines. I have not treated a spinal patient with Bechet’s disorder but I assume the immunological response would be less than normal.

Here is what the internet states about CVID as I have not yet taken care of a patient this this disorder. “CIVD is a disorder that impairs the immune system. People with CVID are highly susceptible to infection from foreign invaders such as bacteria, or more rarely, viruses and often develop recurrent infections, particularly in the lungs, sinuses, and ears. Pneumonia is common in people with CVID”.

CIVD therefore means that you have an impaired immune system and have a harder time mounting a response to an invading bacteria. This would make some sense.

To put this all together, you probably have an active spinal infection with destruction of some of the spinal vertebra and an immune disorder that makes it harder to fight infection. The standard principles of infection treatment however still stand. Identify the organism, find the correct antibiotic to treat it and if the bone develops infection with destruction (osteomyelitis), remove the infected bone.

One of the potential problems is using markers to determine the effects of treatment. I cannot tell you if the standard markers (ESR and CRP) will rise in the face of infection and CIVD and if these markers are valuable to determine if the infection is being treated effectively. I am sure that there have been papers written on this subject but I have not read these papers.

With the destruction of the vertebra, I would assume you need a surgical debridement to remove infected bone. You need a university type of spine program with an expert that has long term experience with spine infections.

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.

[NikkiEvans]

#21940

Thank you! I had the head of UF Neurosurgery do the first surgery, but he retired a few months later. The group is very good, but I wondered if one with more experience with ID would be better.

My biggest problem is finding ones who are willing to treat me…I’ve come to understand their trepidation… However, with a spinal fusion/disc replacement, I am just worried.

Thank you for having this website and helping patients make more informed decisions!! There aren’t many like you out there these days…trust me, I’ve been all over the country looking!!

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