ABSTRACT
A 40-year-old woman with a history of chronic low back pain underwent a fluoroscopically guided intradiscal platelet-rich plasma injection (PRP) at the L5-S1 level. She subsequently developed progressive low back pain, night sweats and decreased ability to ambulate. Laboratory work-up revealed elevated acute phase reactants and imaging revealed L5-S1 intervertebral disc and vertebral end-plate abnormalities highly suggestive of spondylodiscitis. Computed tomography-guided aspiration and biopsy cultures grew Cutibacterium acnes and the patient was subsequently treated with intravenous antibiotics without surgical management. To the best of our knowledge, this is the first published case of lumbar spondylodiscitis following an intradiscal PRP injection, and brings to the forefront several clinically relevant issues including the antimicrobial effects of PRP, the role of C. acnes in spine infections and the ideal treatment protocol for intradiscal biologics in order to minimize morbidity and optimize functional outcomes.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Biological Therapy/adverse effects , Discitis , Gram-Positive Bacterial Infections , Low Back Pain , Lumbar Vertebrae , Platelet-Rich Plasma , Propionibacteriaceae , Adult , Discitis/diagnostic imaging , Discitis/drug therapy , Discitis/etiology , Discitis/microbiology , Female , Gram-Positive Bacterial Infections/diagnostic imaging , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/etiology , Gram-Positive Bacterial Infections/microbiology , Humans , Low Back Pain/diagnostic imaging , Low Back Pain/drug therapy , Low Back Pain/etiology , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/microbiology , Tomography, X-Ray ComputedABSTRACT
Proximal hamstring tendinopathy (PHT) comprises a small but significant portion of hamstring injuries in athletes, especially runners. PHT is a chronic condition that is clinically diagnosed but can be supported with imaging. The main presenting complaint is pain in the lower gluteal or ischial region that may or may not radiate along the hamstrings in the posterior thigh. There is little scientific evidence on which to base the rehabilitation management of PHT. Treatment is almost always conservative, with a focus on activity modification, addressing contributing biomechanical deficiencies, effective tendon loading including eccentric training, and ultrasound-guided interventional procedures which may facilitate rehabilitation. Surgery is limited to recalcitrant cases or those involving concomitant high-grade musculotendinous pathology. The keys to PHT management include early and accurate diagnosis, optimal rehabilitation to allow for a safe return to preinjury activity level, and preventative strategies to reduce risk of reinjury.