51-year-old female for consideration of Posterior Lumbar Interbody Fusion for acute pain management
Background
- Osteomyelitis and Discitis – current inpatient for pain management
- Multiple vertebral crush fractures
- E-coli bacteraemia – resolving
- No nerve root impingement/neurological symptoms
Issues:
- COPD – current smoker. No formal spirometry
- Severe pulmonary hypertension and Tricuspid Regurgitation. Likely Cor-pulmonale
- Exercise tolerance – 50m on flat
- Recent ex IVDU with untreated Hepatitis C
- Childs-Pugh 3 Cirrhosis. Diagnosed following an upper GIH, gastroscopy showed varices.
- No regular gastroenterology follow-up or treatment
Discussion
Perioperative Optimisation
- Consensus that this is a high-risk patient and procedure.
- Undefined bleeding risk, need to assess preoperatively
- Gastroenterology advice should be sought preoperatively
Less invasive Surgical Options
- Main advantage to PLIF is analgesia, no neurological symptoms
- Neurosurgeon feels that vertebrae will self-fuse in coming weeks to months and results will be similar
- On discussion of co-morbidities surgical team have decided the procedure is currently too high risk for the indication
Plan:
- Delay currently
- Neurosurgical team to organise Gastro consult