Table 2.
Parameter |
Patient |
||
1 |
2 |
3 |
|
Sex | M | M | M |
Age, y | 55 | 35 | 34 |
Prior surgery | No | L4-5 microdiscectomy and laminectomy in 2015; revision in 2016 with postsurgical CSF leak | No |
Prior steroids | Methylprednisolone dose pack 3 mo prior | Corticosteroid epidural, date unknown | Yes |
Previous injection | Lumbar facets with Regenokine | Corticosteroid epidural, date unknown | Yes, intradiscal LP-PRP twice |
Injectate | BMC | BMC | BMC |
IV antibiotics | Yes, cefazolin | Yes, cefazolin | Yes, cefazolin |
Antibiotics in contrast | Yes, 500 mcg gentamycin | No | No |
Levels injected | 2, L4-5, L5-S1 | 2, L3-5, L4-5 | 2, L4-5, L5-S1 |
Levels with complication | 1, L5-S1 | 1, L3-4 | 1, L4-5 |
Confirmed pathogen | No | No, culture of fluid collection negative | Yes, C acnes |
ESR (mm/hr) | 115.5 | 49 | 41 |
CRP (mg/L) | 35 | 4.9 | 82.9 |
WBC (109/L) | 8.6 | 6.3 | 7.3 |
Fever | No | Yes | Yes |
MRI findings | Endplate edema | Endplate edema | Endplate edema |
Treatment | IV cloxacillin and oral rifampicin and moxifloxacin | IV cefepime, ceftriaxone, and steroids | IV ceftriaxone and oral amoxicillin |
Outcome | Clinical improvement | Clinical improvement in pain after systemic steroids | Persistent pain leading to consideration of surgical fusion |
Abbreviations: BMC, bone marrow concentrate; CRP, C-reactive protein; CSF, cerebrospinal fluid; ESR, erythrocyte sedimentation rate; IV, intravenous; LP, leukocyte poor; MRI, magnetic resonance imaging; PRP, platelet-rich plasma; WBC, white blood cell count.