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Thread: Removal of Infected Fusion Rod?

  1. #1
    Senior Member Zeus's Avatar
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    Removal of Infected Fusion Rod?

    I haven't posted here in a long time, mostly because I've been caught up with everyday life etc, but as some of you know I had my SCI when I was 7 years old and am a C5 complete quad. When I was 18 I had a complete spinal fusion from T1 to L5, to correct the severe scoliosis most paediatric SCIs develop.

    In 2016 I had severe leg spasms which necessitated a Baclofen pump which was ultimately removed because I developed a massive CSF leak. They had to drill a hole in my vertebrae to get the pump epidural needle into my spinal canal, because I had so much bone growth around my vertebrae over the years, which was bigger than the needle and a perfect place to spring a leak. To make a long story short, after 4 surgeries I learnt that I could control my leg spasms by taking 5 mg of Valium twice a day and 10 mg of Baclofen 4 times a day – 4 surgeries for nothing.

    The real downside was that they gave me an infection during those procedures, and in the 4th surgery found puss on my Harrington Rod which they immediately washed out with saline infused with Vancomycin. They also put me on one month of IV antibiotics and 6 months of oral antibiotics – everybody crossed their fingers and hoped for the best (i.e., that the infection was caught early enough that a biofilm had not formed on the rod).

    At the start of this year a cyst appeared on my back and I thought nothing of it, given it had been almost 3 years since my surgeries and I assumed I had escaped a biofilm – how wrong can you be. After cleaning out the cyst, my surgeons found a sinus that tracked all the way down to my rod. They gave me one month of oral antibiotics and basically told me that they will see how long it takes to come back before deciding what to do next.

    Of course 2 months later the cyst is back already and I am faced with 2 choices – removing the rod or considering long-term suppressive antibiotics. Apparently I have a very low virulent strain of pseudomonas coating my rod, so I have taken one week of left-over Ciprofloxacin that I had and the sinus has immediately closed. Now that I have run out my surplus antibiotics I can feel fluid building up under the skin already.

    I know most doctors are hesitant to prescribe long-term suppressive antibiotics, but at the same time my surgeons have said removing the rod will be '10 times' harder than inserting it was because it is now coated with a significant amount of bone. To put it bluntly, they need to chisel a significant amount of bone away in order to remove the rod, but given that my spine is well and truly fused after 26 years I won't need another rod inserted. I am waiting to speak to my head surgeon about the details of the surgery, but I understand that the surgery will be difficult while my recovery should be fairly smooth given that I won't be waiting for any bones to fuse etc (assuming nothing goes wrong again, like becoming septic during a surgery where an infected rod is exposed to your blood supply).

    I guess I am wondering if anyone has had a similar situation, or if the spinal nurses have faced a similar situation? Given that I am 44, do I get the rod removed or do I look for long-term suppressive antibiotics and take the risk of complications down the track? I had 4 surgeries in 2016 that were a complete failure, so I am not exactly thrilled at the idea of another major surgery. What really irks me the most is that my spinal specialist never thought to try Valium and Baclofen at the same time, which have worked amazingly well for me (from crazy spasms to almost 0 in a week). I could have avoided 4 surgeries and an infection in my rod.

    Any suggestions or thoughts are most welcome. Heck, even as a person that is not particularly religious I'm open to thoughts and prayers at this stage...

    Chris.
    Last edited by Zeus; 07-07-2019 at 07:53 AM. Reason: Typos!
    Have you ever seen a human heart? It looks like a fist wrapped in blood! Larry in 'Closer', a play by Partick Marber

  2. #2
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    Chris, this is so horrible, and add in the depressing frustration of finding it could have been avoided with a moderate dose of common drugs. Wretched. The only thing I can add is the experience of my dad. In 2008 he had a spinal operation which introduced infection. He was given a daily dose of Amoxicillin, 500 mg, which thankfully kept him health for the rest of his life. BUT he was 87 at the time of surgery and died at 94, so that is not a very useful data point. In your case success may depend on how much you have already used antibiotics in this life and your use has likely been high.

    This is likely one of the most important decisions of your life. Options are grim and anyone would be extremely wary of signing on for a procedure like the one you describe. Have you sought another opinion? I'd seek out the most highly qualified surgeon I could find and ask his/her opinion on likely outcomes of such an operation.

    Sometimes our only option is to decide which death we are willing to face, Then hope for as much quality living as possible. Sometimes people get very lucky and land the best outcome. I hope that is what you get. Keep us informed.

  3. #3
    Yikes, C. That's a load to face and then some. I hate knowing you are facing so much.

    I'd go for at least a second opinion.

    Has your doctor mentioned implanting antibiotic beads? Small, antibiotic beads are placed strategically inside holes drilled into infected bone when infection there is the issue. The antibiotic beads dissolve over time and can preserve bone while ridding it of infection. I don't know how this would or would not work with a rod, but I'd ask if it were me.

    I'm aware of three CCers (former CCers?) who have had rods replaced, at least one involved a raging infection. I'll see if any will post here or will get in touch with you via Facebook PM with your okay.

    Wishing you kinder, gentler days.

    ~~~M.E.

  4. #4
    Generally, when orthopedic hardware is known to be infected, it is strongly recommended to remove the hardware, then treat any osteomyelitis. Unfortunately, osteomyelitis often cannot be cured even with a 6-8 week course of IV antibiotics, and use of long term oral supressive antibiotics is attempted in hopes that this will keep it under control. This sometimes works, and sometimes does not.

    Has consultation been made with an infectious disease physician or is this all being managed by your orthopedic spine specialist? If you have not been evaluated by the former, I would strongly recommend that you request a referral.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  5. #5
    Senior Member Zeus's Avatar
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    Hi KLD,

    Thank you for the advice! I have already been speaking to the Infectious Diseases team – thankfully I am a patient at Sydney's Royal North Shore Hospital, which is one of the city's tertiary hospitals, so I have access to a broad range of specialities. I have been dealing with 2 senior orthopaedic surgeons, a senior rehab specialist, and the Infectious Diseases team in the background.

    When the cyst was cleaned out in March they found no physical evidence of osteomyelitis – I think that is why the surgeon has repeated that the removal will be "10 times" more difficult than the insertion was. Apparently my bone was very hard and dense around the section of rod they could observe, and showed no signs of bone infection.

    The Infectious Diseases team told me that they grew 3 separate cultures of the puss they found on my rod, and after a full week of growth the pseudomonas looked like a "dead weed” as opposed to a blossoming mushroom. They indicated this was a good sign because I seem to have a low virulent strain of pseudomonas, but we have not really talked about whether long-term antibiotics is an option to avoid removing the hardware.

    From the sounds of things, I think most advise removal of hardware as it is difficult to predict what the pseudomonas is doing inside even when taking suppressive antibiotics. Most doctors I have spoken to discussed the risk of sepsis, but nobody has really discussed osteomyelitis (but I'm guessing that is only a matter of time if I don't remove the hardware).

    Thanks again for getting back to me so quickly. I know every case is different, but in your experience do you have any idea how long the expected recovery of surgery like this is? I will obviously ask my surgeons that as well, but it doesn't hurt to get as many opinions as possible!

    Chris.
    Have you ever seen a human heart? It looks like a fist wrapped in blood! Larry in 'Closer', a play by Partick Marber

  6. #6
    Hardware removal recovery depends upon how much bone has to be removed to get the hardware out, but a typical hospitalization for surgery like this will be just a few days. It can be painful though.

    Once the hardware is out, about 3 months after surgery, we would do an MRI and a repeat CRP (lab test) to determine that there are indeed no signs of osteomyelitis.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  7. #7
    Senior Member Zeus's Avatar
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    Thanks KLD. I spoke to my surgeons on Friday and it looks like my surgery will take approximately 3 hours with a total hospitalisation time of under 2 weeks depending on how quickly the wound heals. This is actually much better than I expected – the surgeons were relieved that no wiring was used in 1992, which can be hard to remove with all the bone growth. As a C5 complete, I'll probably be spared most of the pain, like I was at 18, but I'll keep an eye out for dysreflexia.

    I'm waiting on the Head of Orthopaedics to call me, who has been one of the doctors involved in my care since the age of 7 (37 years ago!). We will probably discuss timing etc., as I don't like the idea of suppressive antibiotics for the rest of my life (with the risk of osteomyelitis etc.). I'm hoping to have my surgery in September so I can enjoy the Southern Hemisphere summer. My back has no current open wound, and I have no infection markers, so the surgeons are in no rush.

    I will keep you all posted. Thanks again for the advice KLD!

    Chris.
    Have you ever seen a human heart? It looks like a fist wrapped in blood! Larry in 'Closer', a play by Partick Marber

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