PMHX Discitis; when safe to inject spine again?

[Ligament]

30 something female patient with L4-5 discitis, diagnosed and treated by ID specialist. Told she was cured bye ID 9 months ago. Was then on oral ABX for 3 more months. Biopsy culture grew out MRSA.

Most likely got it from a right hand infection with bone involvement that preceded the discitis by 1 month.

Has facetogenic lumbago and b/l leg parasthesias.

Here ID doc said as long as her CBC, C reactive, and Sed rate are WNL ok to proceed with any spinal injections.

Are there guidelines or consensus on when it is safe to consider spine injections again after resolved discitis?

---

Members don't see this ad.

 

[drusso]

30 something female patient with L4-5 discitis, diagnosed and treated by ID specialist. Told she was cured bye ID 9 months ago. Was then on oral ABX for 3 more months.

Most likely got it from a right hand infection with bone involvement that preceded the discitis by 1 month.

Has facetogenic lumbago and b/l leg parasthesias.

Are there guidelines or consensus on when it is safe to consider spine injections again after resolved discitis?

Are you injecting steroids or orthobiologics?

 

[Ligament]

Are you injecting steroids or orthobiologics?

Not sure yet.

Could benefit from:
Lumbar facet and epidural interventions

 

[drusso]

Not sure yet.

Could benefit from:
Lumbar facet and epidural interventions

9 months seems long enough if you're staying out of the disc...no data, just a sense for it.

 

[lobelsteve]

I would not risk injecting into her spine. Spidey sense tingling....And I have reviewed several cases where infection as many as 50 years prior was linked to repeat ESI. After treatment and years of resolution. We are not curing any disease with these shots. Stick it to her facets.

 

[SSdoc33]

I would not risk injecting into her spine. Spidey sense tingling....And I have reviewed several cases where infection as many as 50 years prior was linked to repeat ESI. After treatment and years of resolution. We are not curing any disease with these shots. Stick it to her facets.

Mbbs won't work. It's disc pain plus radicular pain. I'd be tempted to offer an epidural if the MRI shows some compression. Otherwise, I'm not sure you would accomplish much

 

[willabeast]

I would check a few ESR's and CRP's . If they are low, you are OK. If they are not low, then no go. Obtain an ID consult to cover yourself.
document no dental issues, no IVD use etc.

https://www.researchgate.net/public..._C-reactive_protein_in_postprocedure_discitis

 

[Ronin1]

She should be fine. I would proceed as normal

 

[bedrock]

She should be fine. However I’d get ID to clear her first to CYA.