Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
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Subject: Re: chemical infection post lumbar laminectomy I have never hear of a "chemical infection". My husband recently,(Oct 26) had lumbar L4-L5 laminectomy with titanium cage insertion for grafting. He was discharged from hospital Oct. 30. The only complication at that time was a recurring fever, but at the time of discharge it was down. Nov. 3rd, VERY suddenly he developed headache, neck ache, burning sensation in tail bone and a fever of 103. He was transported back to the hospital, CT's and all that were done. Main thing showing up was white count of 20,000. His operative Dr. was out of town. The wound at the time was draining very little and had not been draining at home. They did NOT take a culture at that time. They hung Vancomycin, rocephin. An infectious disease dr saw him and changed the rocephin to Fortaz. For the first 2 days in the hospital the wound drained copious amounts of fluid and he was pretty well out of it. After the change to Fortaz he started getting some better. Still no culture taken. The 3rd day he was there, he was much better, fever down but one could watch the wound drip clear fluid, which I took to be CSF. At this point the Dr cultured this fluid. Then he put a stitch over that area hoping to stem the flow. Thank goodness the next day his main Dr came back into town. He said the sheath had somehow been compromised (he was very interested in the suddeness of it) and that CSF had leaked into the surrounding tissues. This in effect caused a chemical rx that his body had recognized as an infection and treated it as such( high wbc, etc.) He called it a chemical infection. As my husband is doing so much better now and will stay in hospital for observation and conti IV antibiotics.....I am happier now, but I have never heard of a 'chemical infection'. Could someone please explain this to me????? The terminology used here is a little confusing, what is being described I think is an inflammatory reaction to a chemical insult. The body reacts to foreign tissues or infection in very similar ways. This reaction involves increased blood supply causing redness, exudation of fluid, heat and pain in the area. This sequence of events occurs regardless of whether the stimulus is a bacteria, a virus, foreign material (like talc from surgeons gloves) or our own bodily fluids which have entered the wrong area. In this case it would appear that CSF leaked into muscle setting up an inflammatory reaction which is indistinguishable from an infection, thence the term chemical infection. Since there is a break in the CSF barrier this should be covered with antibiotics, it seems like your husband is in good hands, I hope this explains your dilemma, and that he continues to improve.
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