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Staph infection following discectomy/laminectomy - then fusion

photoresistorpphotoresistor Posts: 1
edited 05/08/2013 - 8:51 AM in Back Surgery and Neck Surgery
I had an emergency discectomy/laminectomy back in 2007 in response to the sudden onset of cauda equina syndrome, with rapid recovery (no fusion).

For the last two years I've suffered from symptoms caused by a bulging L3/L4 disc. After a number of injections and a rhizotomy it finally got bad enough to warrant surgery. I had a discectomy in December (no fusion again) which resulted in immediate relief. For two weeks that is.

The surgery went longer than expected due to scar tissue from my 2007 surgery, and (unbeknownst to anyone) staph was introduced into the disc space between my L3/L4 vertebrae. Within a couple days of my two-week post-surgical follow up, I went from no pain to extreme pain. I contacted the surgical practice and worked hard to get another appointment to discuss the problem. The decision was made to treat it like a "flare up" and they prescribed physical therapy. However at the second visit the therapist observed something was seriously wrong and recommended I pursue another MRI to find out what was going on in there.

I managed to get another appointment with the surgical practice and was sent next door for an MRI, now about a month after surgery. The staph had completely liquefied the remaining disc, resulting in total disc collapse. By then I was nearly paralyzed with the pain, concentrated in the low back and right hip, barely able to stand or walk. The next week I went into the hospital for a biopsy, which confirmed the infection. It was originally supposed to be an overnight procedure, but I was in for almost a week, fighting a 103 degree fever.

I then started a six week course of IV antibiotics (Vancomycin and Ceftrioxone). I developed a reaction to the Ceftrioxone in about four weeks, and my ID doc switched me to a different antibiotic for the last couple of weeks (can't recall the name). I was pronounced clear a couple days prior to my scheduled L3/L4 surgery, and the PICC line was removed. By this time I was running a pain level between 8-10 on a ten point scale, and could find no position of comfort. For pain management I was taking two Opana a day and up to twelve Hydrcodone, plus Naproxen. Much longer and my liver would fry. I lost nearly 30 pounds of muscle mass in my legs, and could only walk with two canes, extreme effort, and with unbelievable pain in my low back and hips. Having to endure another month before fusion surgery was probably the biggest mental trial of my life up to that point. (Even worse than grad school!) Pro-tip: A laptop and Netflix instant view provided lots of distraction for my mind during those long stretches before exhaustion became strong enough to overwhelm me and provide a couple hours of sleep. The laptop allowed me to go wherever I could to minimize the pain (bed, recliner, floor, etc.). Watched one movie upside down if you can believe it. Whatever works.

My surgeon remained suspicious of infection, and confirmed its presence during the surgery in March (he removed lots of "nasty sludge" from the disc space) and did confirming labs after - lots of staph present. He performed the fusion by the XLIF technique, using a donor bone insert, and two straps with four screws holding it together. I continued on IV antibiotics after the surgery (Cubicin - 500 Mg once daily via IV/PICC).

Donor bone was an absolute necessity, as any synthetic insert or spacer would harbor infection potentially forever. Over time, the body "remodels" the donor bone, replacing it with its own bone cells, integrating it into the body's immune system, which can eventually fight off the staph.

However, the staph will likely continue to cling to the metal implants as long as they remain. I must remain on antibiotics until the bones fuse and the metal straps and screws can be removed.

The pain relief provided by the fusion was immediate and profound. There was substantial post-surgical pain the night I came out of post-op, but it was mainly soft-tissue pain readily managed with a couple hydrocodone every ten hours or so. That first night was pretty rough, but by morning the pain was easily down by half, and I was walking all over the place with my IV rack in tow. I'll take soft tissue pain over that spinal nerve pain any day.

While still in the hospital, we did try to give the Vancomycin a chance again, since it was the Ceftrioxone I'd reacted to before the surgery. However, about 30 minutes after starting the drip, I had a severe reaction, with the worst chest pain of my life. Felt like a steak knife in the heart. They called a code and pretty soon I had a dozen very interested and focused people with a crash cart in my room. Turned off the drip of course, gave me a couple nitro under the tounge, and within another 45 minutes I was back to normal. Did a CT scan, EKG, and some blood labs to be sure but no heart attack. Just a really bad reaction to the Vanc. Too bad because its just about the most weaponized antibiotic available. I really wanted it to work.

By the time I was discharged I was taking a single hydro every eight hours. Down to one every 12 hours in two weeks, and none by four weeks. I was supposed to be down two to three months but I was back at work in two weeks, driving and all that. By four weeks my pain was essentially gone, and my focus went back to trying to rebuild my withered legs. (walking a lot by now).

Last Friday night after mowing the lawn, I was getting out of the shower and unwrapping my PICC line, when it just fell out of my arm dressing and butterfly clip simply failed - must have sweated it off from underneath. Had to go to the ER and have it put back in the other arm.

I'm having my six-week follow up with the infectious disease doctor tomorrow. My numbers have come down a lot, and expect the PICC line to be removed tomorrow - then moving to oral antibiotics for many months, until the metal comes out. Probably get to hit my annual out of pocket again next year. (Yay)

I have developed an odd ache further up in my mid back, which usually comes after sitting and then standing up, disappearing after 5-10 minutes of standing with my shoulders pulled back. My biggest fear is the staph migrating and attacking another spot further up the column, causing pain. However, I discussed it with both my surgeon and PA last week and they didn't seem to find it remarkable. Maybe muscles adjusting to the new normal. I'm crossing my fingers.

Over all, I consider myself extremely lucky. Sure the staph infection was a terrible break, but the fusion results were nothing short of miraculous. At six weeks post-fusion my life is pretty much back to normal, though I continue to strictly observe the no bending, lifting, twisting restriction and wear my brace when doing anything remotely physical. My pain-management doc called me "a motivated patient", indicating faster than usual post-fusion progress. I have friends with more complex problems who continue to suffer severe pain, even after surgery.

My biggest concern is knowing when the infection is actually beaten, as post-surgical labs the first time didn't show it, and I was pronounced "clear" by my ID doc prior to my fusion, only to find it very active. The good news is my surgeon is a suspicious guy when it comes to infection, and he tends to assume the infection remains until clearly proven gone. We'll see.

If you're reading this I assume you're a fellow sufferer looking for information. My heart goes out to you. I hope you find the help and treatment needed to provide some measure of relief, and hope that sharing my experience gives you something to work with.
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  • LizLiz Posts: 7,738
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  • and all I can say is OMG! I applaud you for having made it through this! I can't even imagine the many hours, days and weeks of pain you have had to endure. I am thanking God I have not had to experience this. My one question would be, do they know how you got the staff infection in there? Was it introduced during surgery?
    Angie 46 yo
    Post Discectomy for L5/S1 herniation on 3/22/13. Also have bulge at L4/L5 and minor facet syndrome in one joint.
  • AllMetalAAllMetal Posts: 1,190
    edited 05/08/2013 - 1:27 PM
    As my grandmother says, "You have had a time!" Goodness. I'm so happy to hear you are on the rebound. I know your life was horrible for awhile there! I'll pray for a speedy fusion so you can get hardware removed and back to your pain free/staph free/antibiotic free life.
    33yo mom of two. My surgical history...preadolescence scoliosis, kyphosis, and a hot mess.... 5 spine surgeries and lots of items added I wasn't born with (titanium, peek, surgical steel). Guess cremation is out. TSA loves me.
  • photoresistor said:
    I had an emergency discectomy/laminectomy back in 2007 in response to the sudden onset of cauda equina syndrome, with rapid recovery (no fusion).

    For the last two years I've suffered from symptoms caused by a bulging L3/L4 disc. After a number of injections and a rhizotomy it finally got bad enough to warrant surgery. I had a discectomy in December (no fusion again) which resulted in immediate relief. For two weeks that is.

    The surgery went longer than expected due to scar tissue from my 2007 surgery, and (unbeknownst to anyone) staph was introduced into the disc space between my L3/L4 vertebrae. Within a couple days of my two-week post-surgical follow up, I went from no pain to extreme pain. I contacted the surgical practice and worked hard to get another appointment to discuss the problem. The decision was made to treat it like a "flare up" and they prescribed physical therapy. However at the second visit the therapist observed something was seriously wrong and recommended I pursue another MRI to find out what was going on in there.

    I managed to get another appointment with the surgical practice and was sent next door for an MRI, now about a month after surgery. The staph had completely liquefied the remaining disc, resulting in total disc collapse. By then I was nearly paralyzed with the pain, concentrated in the low back and right hip, barely able to stand or walk. The next week I went into the hospital for a biopsy, which confirmed the infection. It was originally supposed to be an overnight procedure, but I was in for almost a week, fighting a 103 degree fever.

    I then started a six week course of IV antibiotics (Vancomycin and Ceftrioxone). I developed a reaction to the Ceftrioxone in about four weeks, and my ID doc switched me to a different antibiotic for the last couple of weeks (can't recall the name). I was pronounced clear a couple days prior to my scheduled L3/L4 surgery, and the PICC line was removed. By this time I was running a pain level between 8-10 on a ten point scale, and could find no position of comfort. For pain management I was taking two Opana a day and up to twelve Hydrcodone, plus Naproxen. Much longer and my liver would fry. I lost nearly 30 pounds of muscle mass in my legs, and could only walk with two canes, extreme effort, and with unbelievable pain in my low back and hips. Having to endure another month before fusion surgery was probably the biggest mental trial of my life up to that point. (Even worse than grad school!) Pro-tip: A laptop and Netflix instant view provided lots of distraction for my mind during those long stretches before exhaustion became strong enough to overwhelm me and provide a couple hours of sleep. The laptop allowed me to go wherever I could to minimize the pain (bed, recliner, floor, etc.). Watched one movie upside down if you can believe it. Whatever works.

    My surgeon remained suspicious of infection, and confirmed its presence during the surgery in March (he removed lots of "nasty sludge" from the disc space) and did confirming labs after - lots of staph present. He performed the fusion by the XLIF technique, using a donor bone insert, and two straps with four screws holding it together. I continued on IV antibiotics after the surgery (Cubicin - 500 Mg once daily via IV/PICC).

    Donor bone was an absolute necessity, as any synthetic insert or spacer would harbor infection potentially forever. Over time, the body "remodels" the donor bone, replacing it with its own bone cells, integrating it into the body's immune system, which can eventually fight off the staph.

    However, the staph will likely continue to cling to the metal implants as long as they remain. I must remain on antibiotics until the bones fuse and the metal straps and screws can be removed.

    The pain relief provided by the fusion was immediate and profound. There was substantial post-surgical pain the night I came out of post-op, but it was mainly soft-tissue pain readily managed with a couple hydrocodone every ten hours or so. That first night was pretty rough, but by morning the pain was easily down by half, and I was walking all over the place with my IV rack in tow. I'll take soft tissue pain over that spinal nerve pain any day.

    While still in the hospital, we did try to give the Vancomycin a chance again, since it was the Ceftrioxone I'd reacted to before the surgery. However, about 30 minutes after starting the drip, I had a severe reaction, with the worst chest pain of my life. Felt like a steak knife in the heart. They called a code and pretty soon I had a dozen very interested and focused people with a crash cart in my room. Turned off the drip of course, gave me a couple nitro under the tounge, and within another 45 minutes I was back to normal. Did a CT scan, EKG, and some blood labs to be sure but no heart attack. Just a really bad reaction to the Vanc. Too bad because its just about the most weaponized antibiotic available. I really wanted it to work.

    By the time I was discharged I was taking a single hydro every eight hours. Down to one every 12 hours in two weeks, and none by four weeks. I was supposed to be down two to three months but I was back at work in two weeks, driving and all that. By four weeks my pain was essentially gone, and my focus went back to trying to rebuild my withered legs. (walking a lot by now).

    Last Friday night after mowing the lawn, I was getting out of the shower and unwrapping my PICC line, when it just fell out of my arm dressing and butterfly clip simply failed - must have sweated it off from underneath. Had to go to the ER and have it put back in the other arm.

    I'm having my six-week follow up with the infectious disease doctor tomorrow. My numbers have come down a lot, and expect the PICC line to be removed tomorrow - then moving to oral antibiotics for many months, until the metal comes out. Probably get to hit my annual out of pocket again next year. (Yay)

    I have developed an odd ache further up in my mid back, which usually comes after sitting and then standing up, disappearing after 5-10 minutes of standing with my shoulders pulled back. My biggest fear is the staph migrating and attacking another spot further up the column, causing pain. However, I discussed it with both my surgeon and PA last week and they didn't seem to find it remarkable. Maybe muscles adjusting to the new normal. I'm crossing my fingers.

    Over all, I consider myself extremely lucky. Sure the staph infection was a terrible break, but the fusion results were nothing short of miraculous. At six weeks post-fusion my life is pretty much back to normal, though I continue to strictly observe the no bending, lifting, twisting restriction and wear my brace when doing anything remotely physical. My pain-management doc called me "a motivated patient", indicating faster than usual post-fusion progress. I have friends with more complex problems who continue to suffer severe pain, even after surgery.

    My biggest concern is knowing when the infection is actually beaten, as post-surgical labs the first time didn't show it, and I was pronounced "clear" by my ID doc prior to my fusion, only to find it very active. The good news is my surgeon is a suspicious guy when it comes to infection, and he tends to assume the infection remains until clearly proven gone. We'll see.

    If you're reading this I assume you're a fellow sufferer looking for information. My heart goes out to you. I hope you find the help and treatment needed to provide some measure of relief, and hope that sharing my experience gives you something to work with.
    beth1962
  • roxiesrroxies Posts: 8
    edited 05/09/2013 - 12:33 PM
    Thank you for sharing your story.
    beth1962
  • ChappsCChapps Los AngelesPosts: 11
    Wow, I wish I had found this post last year. In March of 2015, I was diagnosed with a very severe herniated disc - it had herniated well up into the spinal column and was causing a huge amount of sciatic nerve pain (it had previously been a bulging disc that had put me in crutches more than once). Because it was so severe, the doctor couldn't perform a steroid epidural - the liquid would just have pressed hard on the nerve. So on April 1, I went in for my surgery, a microdiscectomy and laminectomy. My first surgery. It wasn't a great result, and even more painful in the days to come. I have ankylosing spondylitis so my rheumatologist was keeping a close eye on me and didn't like the way I looked. He wanted me to keep track of my temperature and head directly to the emergency room if it spiked. Which it did the very next day - 103 and climbing. So, on April 8, I headed into emergency surgery with a staph infection for a cleaning and debridement. I had to stay a week in the hospital - the infection had been so severe that it was in my blood and stressing my organs. Because I was on vancomycin, my veins had collapsed and so I had to have my IV insertion point changed up to twice a day. But I lived and finally went home.

    I thought things were getting better, but I began to experience severe pain in my spine again (not that it had ever ended) and my fever returned. So, on May 1, I was back to the emergency room and emergency spinal surgery. Clean and debride. Because I was already using a PICC line, I didn't have to stay more than two days in the hospital. After an additional six weeks on my PICC, I transitioned to oral antibiotics for three months. I was beginning to rebuild my legs, after learning to walk all over again and feeling good. But within two weeks of stopping the oral antibiotics, I began to feel weak and was having trouble getting out of bed. I decided to visit my rheumatologist, and on the way there, my fever spiked again. I was in a very bad way when I got there, with a 104 degree temp, and my doc put me in a wheelchair and personally wheeled me two blocks to the emergency room. This time, because I was over three months past the third surgery, I could switch surgeons. But the staph was back in my blood and worse than ever. They needed two weeks to stabilize me before my fourth surgery. The staph had liquified my disc (sound familiar?) and so I also needed to have fusion performed - two rods and four screws. For someone with AS, this is terribly and disappointingly ironic. After surgery, I was on a lot of pain meds, but my lower spine finally felt solid. 

    Anyway, over several months, I've relearned again how to walk, strengthened my legs (I still have bad numbness and nerve pain) and doing very well. I still have spinal pain and unfortunately can't treat my AS with biologics any longer, since biologics can lower the immune system and staph may still be present, due to the metal in my spine. I don't know if I even have the option to remove the metal for the foreseeable future, and I really don't want to face another spine surgery. Staph had badly affected my life and nearly killed me - but I lived and I'm thriving. And in the last couple of months, I've been rid of that feeling that I was permanently broken. No moral to this story, but after that year (in which both my parents died - my mother of staph after surgery - as well as my father-in-law), I'm grabbing a hold of life and making big changes. Onwards.
  • No_No_No_YesNNo_No_No_Yes Sacramento Ca.Posts: 23
    Staph infections are a horrific thing, and I have experienced first hand they can be lethal - I lost a daughter at 28 days old to one. Was any mention made as to where this infection originated from? I was watching one of the evening news magazine shows, one of the anchors had lost a husband who was in for a very minor surgery - a result of staff. It turned out that the hospital in question had an outbreak situation and it had gone unchecked. As she detailed things further it rang a lot of bells for me, similar things to what had gone on when we lost our daughter. To simply say infections happen - well yes that is true to an extent, but if they had an outbreak situation happening when you checked in and you were not made aware of it, they can be held liable (that anchor sued the pants off of the hospital and won). Now I know many feel we live in a far too litigious society, but frankly if they had a situation - you were owed the right to decide whether or not to roll the dice to have your operation done there. We were so overcome with grief, we never asked the questions at the time even though the writing was on the wall. Several other infants died the same way all within days. 

    I'm glad your doing better now, and I hope you continue to get stronger!
  • ChappsCChapps Los AngelesPosts: 11
    I'm so sorry to hear about the loss of your baby daughter - it breaks my heart to hear that. Staph is an insidious killer. While I was between surgeries, my mother contracted staph after hip surgery and died a few months later. Trust me, that was utmost in my mind when I was rushed back into the hospital with 104° fever. Two weeks and one fusion surgery later, I was finally able to go home again. The original surgeon (first three surgeries) tried to insist that it was all my fault - that the naturally occurring staph dermatitus magically got into my bandaged wound and became staph aureus. Then he tried to blame it on my biologic medication (I was taking Simponi for my ankylosing spondylitis - an autoimmune/autoinflammatory arthritis), then he blamed my AS - everything but himself. I learned from other people who went through the same surgery that they were told to prep for surgery by sterilizing the pre-op site for days prior to surgery. The surgeon's team really took a loose approach to infection in the first surgery. Of course, by the second surgery, they were scrubbing my whole body before surgery and wiping the inside of my nostrils with antiseptic. 

    By the fourth surgery, the hospital knew they were in deep trouble with me, and I was given a large suite with views and luxury meals prepared by their four-star chef (usually reserved for the rich folks). I haven't yet sought out a lawyer to discuss a lawsuit, mostly because I wanted to save all my energy for my recovery. I also didn't want to be looking backward to a really painful time. Before all these surgeries, I was in top physical condition, slim and muscular. Now I'm 30 lbs heavier and slowly regaining my strength. With the fusion, I'll certainly never have the flexibility I used to have. And I can't take my biologic medication while there's still metal in my spine, because it could suppress my immune system and cause the staph to come back. So, without any treatment, my AS is making life very difficult, and my fingers have begun to warp and a couple of other vertebrae are beginning to fuse (a hallmark of AS), all which had been held at bay by the biologic meds. Very frustrating. I feel that the hospital knew that they had a problem (they had a few deaths from staph the year before my surgeries) and didn't go to the nth degree to prevent infections. I hate litigation, but I'm keeping my options open. My bills were nearly $1 million, but insurance fortunately paid nearly everything. But I had to be on top of the insurance company every single day, forcing them to pay for my home nurse, my IV pump, my supplies, my hospitalizations, my MRIs, everything. We were still left with tens of thousands of dollars in bills. I know that staph is a problem at many hospitals, but I also feel that hospitals haven't spent the money and resources to address the problem - mostly because it affects their bottom line. Yet another problem with profit being the most important part of healthcare in the U.S. But, I'm very lucky to be alive - I just wish my mom had been as lucky.
  • k5S1MDkk5S1MD Ontario, Canada Posts: 1
    It's too bad you couldn't stop your biologic prior to your surgeries. That's what I did. But I find myself concerned about a possible infection after this last surgery two weeks ago even with stopping my biological pros-op. 
    What were your early symptoms of "deep" surgical infection? 
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