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Infective spondylodiscitis case 2
- 1. CASEOF SPONDYLODISCITIS 2 By Dr Kota Gandhi II yr PG Orthopaedics Kamineni Institute of Medical Sciences
- 2. Chief Complaints : • A 16 year old male patient presented to the OPD with chief complaints of : • Pain in upper back since 20 days • Swelling in upper back region. • Difficulty in walking since 5 days. Unable to walk without support.
- 3. History of present illness • Patient was apparently asymptomatic 20 days back, later developed sudden pain in upper back inter scapular region which was insidious in onset and progressive. Pain was continuous in nature, throbbing type, radiating to both lower limbs associated with paresthesia. Aggravated on movements and not relieved with rest. • 5 days back severity of pain increased with difficulty to walk and weakness in both lower limbs.
- 4. • Swelling in the thoracic spine region which was progressively growing and attained the size of about 3x4 cm.
- 5. General Examination • Patient was conscious, coherent, cooperative • Thin built and moderately nourished • Temp :98.5degrees Fahrenheit • BP :110/80 mm of Hg • PR : 84 beats/min • RR : 20cycles/min • Weight : 43 kg
- 6. Local Examination • Swelling of 3x4 cm at D4-D5 vertebral levels • Tender, Firm in consistency, immobile, ill defined margins • No kyphosis, scoliosis, lordosis • Left lower limb power 3/5 • Right lower limb power 4/5 • Ankle clonus positive bilaterally • Sensations normal on both sides.
- 9. Investigations • Hb : 12.6 g/dl • TLC : 8,200 cells/cumm • Platelets : 4.46 lakhs/cumm • RBS : 84 mg/dl • B/G/T : B positive • TSB : 0.60mg/dl • Direct : 0.19mg/dl • Sr.Creat : 0.9mg/dl • Sr.urea : 29mg/dl • Sr. sodium : 141 mmol/L • Sr. potassium : 4.3 mmol/L • Sr.chloride : 100 mmol/L • Serology : non reactive.
- 10. Diagnosis • D5 D6 infective Spondylodiscitis with partial collapse of D5 vertebra with bilateral paraparesis without bowel and bladder invovlement.
- 11. Surgery • D3D4-D6D7, pedicle screw fixation + deformity correction+biopsy
- 14. POD 1 • Patient was conscious, coherent, cooperative • Temp :99 degrees Fahrenheit • BP :120/70 mm of Hg • PR : 98 beats/min • RR : 22cycles/min • No wound soakage • Distal pulses felt • No neurological deficits present
- 15. • Inj.Monocef 1gm IV/BD • Inj.Metrogyl 100 ml IV/TID • Inj. Amikacin 500 mg IV/OD • Inj.PCM 500mg IV/TID • T.Pantop 40mg OD • Incentive Spirometry • Patient was empirically started on Antitubercular treatment with AKT 4. 1 pack per day
- 16. From POD 2 the patient was given regular physio and galvanic stimulation left limb power improved with power 4/5.
- 17. • Intra operatively samples sent for gene expert, histopath and cultures. • Gene expert was negative. • Histopathology report signs of chronic granulomatous disease suggestive of Tuberculosis. • Cultures were positive for Coagulase negative cocci with sensitivity to clindamycin.
- 18. Treatment cont. • Inj.Clindamycin 300mg in 100ml NS over 30 min IV/TID • Tab AKurit-4 3 tab OD • T.Ibugesic plus BD • T.Osteocalcium OD • T.MVT OD
- 19. At the time of discharge patient have both limbs power 5/5 and discharged with advice to continue clindamycin for 3 weeks and akurit 4.