Infective spondylodiscitis case 2

Infective spondylodiscitis
Case of spondylodiscitis
TB spine
Tuberculosis of spine

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.

7. 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.

8. Diagnosis D5 D6 infective Spondylodiscitis with partial collapse of D5 vertebra with bilateral paraparesis without bowel and bladder invovlement .

9. Surgery D3D4-D6D7, pedicle screw fixation + deformity correction+biopsy

10. 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

11. 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

12. From POD 2 the patient was given regular physio and galvanic stimulation left limb power improved with power 4/5.

13. 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.

14. 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

15. 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.