We began the day with two surgical cases. Firstly, a young lady named Rose. She presented several days ago with lower extremity weakness and a fracture in her lower thoracic spine that was causing spinal cord compression. We initially thought this was from a traumatic event five months prior, but during the surgery we found evidence of infection in her spine, which may have been the cause of her fracture to begin with.
The second case was very similar: a man with fractures of his T12 and L1 vertebral bodies. The appearance of the fracture on his CT suggested that infection was involved, and when we opened his back and began to access the fracture site, we spotted infectious material for the second time that day. We removed as much of the infection as we could (we had to remove some of the vertebral bodies themselves, as the infection had eroded the bones, making them unsuitable for fusion) and placed an interbody graft into the leftover space. We also placed some antibiotic powder into the area, doing our best to kill any leftover pathogens.
Dr. Lieberman has an interesting ritual at then end of his cases: he says a little “prayer” to the spine gods, asking that they grace the patient with a good outcome. After operating with Dr. St. Clair over the last two days it has become apparent that he has several rituals of his own. When placing vancomycin powder into a wound, for instance, he will, without fail, exclaim, “Bugs be gooooooone! Be gone! Be gone! Be gone!” This makes me laugh every time, but he insists that it is entirely necessary for the antibiotics to be effective.
Between the first and second case, Dr. St. Clair saw a young lady in clinic who had been in yet another boda boda accident (she was walking along the side of the road when a boda boda veered out of his lane and crashed into her). This poor lady had jumped facets at C4/5 resulting in spinal cord compression and quadriplegia. Unfortunately for her, the injury was once again days before we saw her, and thus the hope for recovery of limb function was dismal. Still, she was in pain from her neck injury and in need of stabilization. We reduced the jumped facets from an anterior approach and stabilized her spine at the level of injury with instrumentation.
As mentioned in a previous post, Julius (the patient with Pott’s disease of the spine who underwent a big fusion several days ago) has no family or visitors to attend to him, and Michelle has been kind enough to give him a little extra attention. Today, Michelle and Jordan took it upon themselves to give Julius a bath. With some assistance from others in the hospital, they took Julius outside and gave him a good scrubbing, which I am sure he appreciated.