Staph infection following discectomy/laminectomy - then fusion

Staph infection following discectomy/laminectomy - then fusion

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photoresistor
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Joined: 05/08/2013 - 12:40pm
Staph infection following discectomy/laminectomy - then fusion

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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Liz
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anjsmiles
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Last seen: 1 year 1 week ago
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Joined: 04/06/2013 - 8:57am
Just read your story out of curiosity....

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.

AllMetal
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Last seen: 1 month 1 week ago
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Joined: 11/03/2012 - 6:43pm
Geez!

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.

roxies
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Last seen: 1 year 4 months ago
Title: Member
Joined: 11/05/2012 - 8:01pm
Thank you very much for sharing your story.

photoresistor wrote:
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

roxies
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Last seen: 1 year 4 months ago
Title: Member
Joined: 11/05/2012 - 8:01pm
Bad pain day.

Thank you for sharing your story.

beth1962