Care of patient with spondylodiscitis

Gowri Sankari

Staff Nurse, Kauvery Hospital, Salem, Tamil Nadu

Background

A 53 years aged lady presented with complaints of abdomen pain and back pain radiating around chest wall to epigastric region and weakness of both lower limbs for past 1 month.

On Examination

On admission patient was conscious oriented & afebrile. Patient was unable to move & walk. Both legs were swollen.

Vitals Signs: Normal

Investigation

CBC

  • Haemoglobin: 10.9
  • PCV: 33.3
  • Total RBC Count: 3.78
  • MCV: 88.1
  • MCH: 32.7
  • RDW-CV: 13.9
  • Total WBC Count: 6180
  • Neutrophil: 66.5
  • Lymphocyte: 23.8
  • Monocyte: 5.8
  • Basophil: 0.8
  • Platelet count: 40
  • MPV: 9.1
  • RBS: 105 mg/dl

Venous Doppler Lower Limb

  • IVC is obscured
  • Left common femoral, superficial femoral and popliteal veins appear smaller in caliber with circumferential thickening and central color flow – DVT
  • No significant color flow in left posterior tibial vein

MRI – Cervical Spine

  • Inter vertebral disc destruction at D5 – D6 vertebral level with collapse of D5 vertebra
  • T2 hypo intense content with diffusion restriction & calcification in pre and para vertebral space at D5 – D6 level
  • Posterior disc bulge at C3 – C4 to C5 – C6 levels causing ventral thecal sac indentation.

Culture

Blood culture report – No growth in culture

2D Echo

  • Concentric LVH (+)
  • Global hypokinesia of LV
  • LVEF – 42%
  • Moderate MR (+)
  • Moderate LV dysfunction

Immediate Management

  • Patient was started on Inj: Cefoperazone & Sulbactum twice a day
  • Paracip 1gm IV SOS
  • Inj: Tramadol 50 mg IV BD
  • Inj: Emeset 4 mg IV BD

Patient referred for surgery immediately

Surgical Management

D5 – D6 decompressive laminectomy & drainage of epidural abscess was done at 18.03.2025

After Surgery Investigation

Mycobacterium Tuberculosis DNA PCR

Specimen of TB PCR – Tissue

Mycobacterium tuberculosis complex – Detected (Low)

Culture

Specimen – D5 – D6 vertebral spendylodiscitis with epidural abscess

Impression: Suggestive of necrotizing granulomatous lesion

Advised ancillary studies for tuberculosis

Nursing Management

  • Complete bed rest
  • Assessing patient and focuses on pain management
  • Monitoring neurological status
  • Ensuring spinal immobilization (e.g.: Back braces)
  • Protein rich diet advise
  • Back care
  • Pressure ulcer prevention
  • Anxiety and coping support
  • Physical therapy (e.g., breathing exercise, trunk balance exercise, balance exercise, functional activities)
  • Active or active – assisted range of motion exercise.

Day 10

On the day of discharge, her back pain and weakness was settled and she felt better. She gradually recovered. She was discharged as per doctor’s advice.

Discharge Treatment

Tab. Rifampicin450 mgOD
Tab. Ethambutol800 mgOD (Alternative Days)
Tab. Isoniazid200 mgOD
Tab. Pyrazinamide1.5 gmOD (Alternative Days)
Tab. Benadon40 mgOD
Tab. Neurobion ForteOD
Tab. UltracetSOS
Tab. Sompraz40 mgOD (BF)

Preventive Measures

Regular hand washing and proper wound care can help prevent the spread of bacteria (Good hygiene). A balanced diet and regular exercise can strengthen the immune system and make it more resistant to infections (Healthy lifestyle).

Kauvery Hospital