Podcast: Play in new window
History :
The 50-year-old man came to Spine Pain Treatment in Pune Dr. Sangram Rajale with complaints of lower back pain for 15 days, which had started radiating down his left leg 14 days ago. He had also undergone incision and drainage for an infection abscess on his right thigh 20 days back under spinal anesthesia. He had paralysis in both legs, and had been confined to bed and was unable to urinate, leading to severe stomach pain.
He also had recurring leg pain, numbness, and tingling sensations, likely stemming from decades of heavy lifting, such as gas cylinders. Additionally, he had been experiencing sleep disturbances due to the pain and had been running a fever for the past 3 days.
O/E OF SPINE:
The patient had Para Spinal Muscle Spasms in the lumbar spine, with swelling and tenderness specifically on the left side at the L3-L4 level. Straight Leg Raise (SLR) was painful and limited on the left side. He experienced increased lower back pain during activities like turning in bed or sitting down and getting up. There was reduced strength in his left knee and hip, around 4/5, and limited ankle dorsiflexion and plantarflexion at 2/5. Additionally, his Extensor Hallucis Longus (EHL) and Extensor Digitorum Longus (EDL) strength were around 2/5.
MRI :
A well-defined epidural collection was observed at the L3/4 level, resulting in severe narrowing of the Spinal cord. There is also edema visible in the paraspinal soft tissues, and the spinous process appears to be affected. These findings suggest an infectious etiology.
Operation :
On October 1, 2023, the patient underwent a L3-L4 laminectomy and decompression, along with debridement and posterior spinal fixation using Jayon implants. The procedure was performed by Top Spine Specialist in Pune Dr. Sangram Rajale under general anesthesia. A biopsy and pus culture were taken, revealing Methicillin-sensitive Staphylococcus aureus infection. Consequently, treatment with intravenous Cloxacillin 2gm every 4 hours was initiated and continued for 6 weeks.
Condition On Discharge :
Before surgery, the patient had moderate strength in his hip and knee muscles (rated 4/5), while his ankle muscles had weaker strength (rated 3/5). his foot muscles (EHL and EDL) were also weak, rated at 2/5. After surgery, the patient showed improvement in ankle strength, with dorsiflexion and plantarflexion now rated at 5/5. The extensor muscles in the foot (EHL and EDL) also improved to 4/5.
Overall, there was significant enhancement in strength postoperatively, especially in the ankle and foot muscles.