Rebecca Takele, DO
PM&R Resident Physician
SUNY Downstate Health Science University
Brooklyn, New York, United States
Austin Manjila, MD
Resident Physician
SUNY Downstate Health Science University
Brooklyn, New York, United States
Raheel Shah, DO
Physician Resident
SUNY Downstate Health Science University
Brooklyn, New York, United States
Simron Gill, MD
Resident
SUNY Downstate Health Sciences University
New york, New York, United States
Haris Choudry, MD
Residency Program Director
Burke Rehabilitation Hospital
New York, New York, United States
Sanjeev Agarwal, MD
Program Director
SUNY Downstate Health Science University
Brooklyn, New York, United States
A 24-year-old female presented with 12 days of worsening back pain radiating to both hips and groin after carrying heavy baggage. She denied urinary or fecal incontinence or saddle anesthesia. Initial lumbar computed tomography (CT) and magnetic resonance imaging (MRI) revealed L4/5 paracentral disc extrusion with severe spinal canal stenosis and contact with the left L5 nerve root. Patient subsequently underwent a L4-5 microdiscectomy and was admitted to acute rehab where she developed worsening spastic left leg radicular pain and right groin pain radiating to her lateral thigh and anterior calf. Her motor strength with bilateral hip and knee flexion and extension were 2/5, sensation in all extremities initially intact and reflexes 1+ throughout. Lumbar MRI showed L3-L4 discitis and osteomyelitis with surrounding paraspinal soft tissue infectious changes, L4-L5 right paraspinal fluid loculation possibly a seroma, and posterior broad-based disc protrusion with underlying annulus tear at L4-L5.
Discussions:
Microdiscectomy is indicated for patients with herniated discs and severe radicular pain, significant neurological deficits, cauda equina syndrome or who have failed conservative treatment. The procedure generally is successful in 9 of 10 patients with most returning to normal activities afterwards. However, nerve injury, reherniation, persistent symptoms and rarely discitis and osteomyelitis may be complications. Despite our patient not having typical risk factors such as advanced age, immunosuppression, long corticosteroid use, diabetes, intravenous drug use, or surgical instrumentation placement, she was found to have discitis and vertebral osteomyelitis.
Conclusions: We present a rare case of vertebral osteomyelitis and discitis following microdiscectomy. Even with minimal risk factors, there should be a high clinical suspicion in patients with sensory loss, weakness, and radiculopathy after microdiscectomy. If undiagnosed and untreated, patients may develop fractures, paralysis, permanent neurological deficits, chronic pain, and disability.
