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07-JANUARY-2010  NASER IBRAHEEM ISSA  COMPLICATED PEEK SATELLITE WITH DISCITIS  FOR PLD L5-S1

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Anamnesis:

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The patient was operated by me 31-August-2009 for extruded disc L5-S1 with insertion of PEEK Satellite sphere to prevent recurrence.

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The patient was doing well for 1 month after what the LBP and scoliotic stance took place as before surgery.

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The patient then came 18-November-2009 with the same complains and exaggerated scoliotic stance and SLRS 20 degrees in the right with hypalgesia right L5 root territory.

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MRI lumbar spine done 19-December-2009 showed no recurrence with evidence of reactionary changes of the L5 and S1 endplates.

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Dalacine C 300 mg was started for 6 months course and lumbosacral support was advised. The patient was seeking another opinions and the doctors gave him various opinions that the patient became confused with his problem. Some doctors even gave him report that his surgery was a wrong one as the report given by his Excellency Dr. Rakan Shhaltogh.

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The patient then came 27-December-2009 complaining of the same scoliosis with SLRS 60 degrees in the right without neurological deficit. He was sent for another MRI which was the same as the previous one, but with increase of the inflammatory changes, and the X-ray showing the the sphere in the right side of the L5-S1 disc space. CRP was 45 and ESR was 36 mm/h.

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The patient then came 06-January-2010 urging to remove the PEEK Satellite sphere, because most of the doctors convinced him, that the device must be removed. It was explained to the patient that the main problem is discitis which needs conservative treatment for 6-8 months and removal of the sphere will probably not correct his condition.

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The old incision refreshed and the right S1 root was exposed, trying during that not to violate the lateral masses of L5-S1 right side. 3-4 ml fluidy collection came out from the disc space, which was collected and sent for CXS. Inflamed disc material was sucked and trail to remove the movable sphere with its insertion device failed, because the sphere was movable. Using various instruments to remove it failed. Using the sequester forceps could hold the sphere and removal was achieved without problems. The disc pace was empty and meticulous cleaning with H2O2 and Gentamicin was performed several times.

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Routine closure of the wound and smooth postoperative course.


Comments

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PEEK Satellite sphere has problems among them allergic reactions, which could trigger the evolution of discitis.

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Using the curette as a routine step of surgery before the insertion of the sphere violate the endplate, which could help in the spread the inflammatory changes in the bone. This routine step must be questioned and mostly avoided to prevent endplate injury.

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Discitis have place even without PEEK sphere insertion, and it requires long-term treatment.

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Medtronic must declare if the PEEK is an inert material and in case of discitis, to remove the sphere as soon as possible! or to treat the discitis leaving the sphere in place.

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Instead of using the curette , another device must be included in the set for removal of the sphere as in this condition.

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New technologies hide with them new comorbidities, with which the neurosurgeon must improvise their best solution.


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