Tests for infection status?

[mmglobal]

I've been talking to someone who is having severe pain 3 weeks post-op from a 3-level endoscopic lumbar procedure. Doctors ordered sed rate (blood work) and bone scan.

I'd like to have a discussion about what these tests are and what they'll show.

Mark

[paindoc]

I would first like to say that in no way am I advocating information taken off the internet be used to supercede the information you receive from your physician. It sounds like you've had an endoscopic discectomy, and are having continued pain. You doctor has ordered the ESR to determine if there is any inflammatory process occurring. The problem is that the ESR can be elevated by just performing the procedure. It is very non-specific and a c-reactive protien level in my opinion would be a better study. The bone scan was ordered to see if there is any evidence of discitis which is an infection in the disc space. This test is used to identify bone growth or destruction. It can show infection, tumor, and metastisis. A radioactive substance is injected and either not taken up "cold spot" or taken up "hot spot" by a particular tissue. If there is an infection there may be a "hot spot" at the endplates of the corresponding disc. Unfortunately, there studies are notoriously negative so that ifyours is negative it does not mean discitis is not present. A follow up MRI or CT scan may be in order to looka t endplate sclerosis. You may also see this on a plain film with disc space narrowing. Some physicians will also order a white blood count. The disc doe not have a blood supply, so the body may not be mounting a defense and therefore your WBC may also be normal. The diagnosis is often clinical. Symptoms of discitis are exqusite pain, fever, and often an unwillingness to ambulate. I hope this helps you understand a little better. If you have any spcific questions, your personal physician is your best resource.

[mmglobal]

Well, we are now 3.5 weeks down the road from where we were when I posted the original question. I have to say a special thank you to paindoc for the info he posted here. Without it, I'm not sure that my client's discitis and osteomyelitis would have been discovered in a timely manner.

As the question indicates, he was screened for discitis about 3 weeks after his surgery with blood work and a bone scan. Both were unremarkable. Negative on the bone scan. Some levels were elevated on the labs, but not anything that got his doctors too excited. Also, many of the elevated values are commonly elevated after surgery.

Fast forward another 3 weeks and the client has seen a couple of doctors who reviewed the negative screening process and recommended waiting and conservative therapy since he was so recently operated. (Good advice!) However, the patients condition continued to deteriorate. He was comfortable while lying down, but getting up and about often brought the most serious pain and muscle spasms. He was unable to do anything and feared not even being able to get to a doctor. I was able to facilitate a prescription for lab work and the patient arranged for a home health care provider to come to him to draw blood. Results the next day indicated that the levels that had been slightly elevated weeks before had gone in the wrong direction. A private ambulance ride took him to the hospital. He was admitted and an MRI confirmed discitis and osteomyelitis. Thankfully, it's caught early enough to give high confidence of successful treatment that is MUCH less invasive than what may have been required if it was caught later.

I'll post more as I learn it...

Mark