Putra, I Gusti Ngurah Paramartha Wijaya
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Surgical Precision in Lumbar Spinal Canal Stenosis: Optimizing Outcomes in a Young Adult with Suspected Infection through Decompression-Stabilization-Fusion Putra, I Gusti Ngurah Paramartha Wijaya; Febyan; Ustriyana, Nyoman Gede Grenata Nanda
Indonesian Journal of Medicine Vol. 9 No. 2 (2024)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/theijmed.2024.9.2.747

Abstract

Background: This case report examines the uncommon occurrence of Lumbar Spinal Canal Stenosis (LSCS) in a 23-year-old male patient, highlighting the diagnostic challenges and unique aspects of managing this condition in young adults. Typically associated with aging and degenerative changes, LSCS poses a diagnostic dilemma when encountered in a young individual with nonspecific causation. Case Presentation: The patient reported persistent lower back pain since February 2023, primarily on the right side, escalating over the past three months. The pain intensified during prolonged sitting, standing, and walking, alleviated by lying down and analgesics. Radiating pain to both buttocks and legs, particularly on the right side, accompanied a four-month history of persistent right foot numbness. Referred from RS Siloam Kupang to RSAD Denpasar and subsequently to RSUP Prof IGNG Ngoerah, the patient received a diagnosis of Lumbar Spinal Canal Stenosis at L2-L3-L4, L5-S1, with suspected Spondylitis TB. Results: This case underscores the intricacies of diagnosing Lumbar Spinal Canal Stenosis in young adults, emphasizing the exploration of non-traditional causes. The patient underwent Debridement-Decompression-Stabilization-Fusion-Biopsy+Culture, experiencing postoperative improvement. Cultures showed no growth, and biopsy results were nonspecific. The final diagnosis was Lumbar Spinal Canal Stenosis at L2-L3-L4, L5-S1 due to Spondylitis TB dd/Pyogenic Infection, with bilateral Neural Foraminal Stenosis Grade III at L5. The discussion focuses on the rarity of this presentation in young individuals, challenges in diagnosis, and the efficacy of decompression-stabilization-fusion treatment for achieving positive outcomes in young adult patients. Conclusion: The case discussion emphasizes the complexity of managing Lumbar Spinal Canal Stenosis in a young adult, particularly when infection is suspected. The decision to pursue Decompression-Stabilization-Fusion was rooted in the patient's age, the need for structural stability, and the suspicion of infection.
Paraspinal Abscess Secondary to Spondylodiscitis: A Rare Presentation with Progressive Neurological Deficits and Systemic Infection Putra, I Gusti Ngurah Paramartha Wijaya; Wijaya, I Gusti Ngurah Paramartha; Febyan, Febyan; Yulian, Kenny
Indonesian Journal of Medicine Vol. 10 No. 2 (2025)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/theijmed.2025.10.2.842

Abstract

Background: Spondylodiscitis is a rare but serious spinal infection that may result in neuro-logical and systemic complications, especially when associated with paraspinal abscess formation. This case highlights its clinical severity and the importance of early intervention. This study aims to highlight the clinical importance and potential severity of spondylodiscitis, particularly when complicated by paraspinal abscess formation. Case Presentation: A patient presented with progressive lower back pain, bilateral lower limb weakness, and systemic symptoms including fever and night sweats. Laboratory tests revealed hypoalbuminemia, leukocytosis, and anemia. MRI imaging identified a paraspinal abscess at the L3–L5 levels, resulting in lumbar canal stenosis and worsening neurological deficits. Emergency surgical intervention was undertaken, consisting of abscess drainage, laminectomy for neural decompression, and posterior spinal stabilization. Intraoperative findings included a substantial purulent collection, necessitating extensive debridement. Postoperatively, the patient demonstra¬ted clinical improvement with ongoing antibiotic therapy, nutritional support, and rehabilitation. Discussion: Spondylodiscitis with paraspinal abscess is a diagnostic challenge due to its insidious onset and non-specific presentation. Delayed recognition increases the risk of severe neurological impairment and systemic sepsis. MRI is the gold standard for early detection, while micro¬biological confirmation is crucial for targeted treatment. A multidisciplinary approach is essential. Surgical intervention is indicated for progressive neurological deficits, extensive abscess formation, or spinal instability, with timely antibiotic therapy playing a critical role in infection control. Conclusion: This case illustrates the importance of early diagnosis and timely surgical manage-ment in spondylodiscitis with paraspinal abscess. Multimodal treatment improves outcomes and helps prevent long-term disability.