Post-operative pyogenic spondylodiscitis and epidural abscess

Case contributed by Dr Mohammad A. ElBeialy

Presentation

Lower back surgery since a month with a recent onset of back pain and right foot drop.

Patient Data

Age: 40 years
Gender: Female
  • status post-operative with right L5 fenestrated hemi-laminectomy.
  • evidence of L5/S1 spondylodiscitis with altered signal of the L5/S1 disc showing some residual T2 hyperintensity and post-contrast enhancement as well as irregularity and ill-definition of L5 and S1 opposing vertebral end plates with subchondral oedematous marrow changes demonstrating post-contrast enhancement as well.
  • associated L5/S1 epidural marginally enhancing lesion is seen demonstrating low T1 and mildly hypertense T2 signal as well as L5/S1 residual posterior disc extrusion is seen obliterating the anterior epidural fat and compressing the thecal sac with partial narrowing of the subarticular lateral recess of L5 and S1 with impingement of the right L5 and S1 nerve roots as well as encroaching upon both neural exit foramina.
  • the enhancing inflammatory soft tissue is seen tracking along the right L5 hemi-laminectomy and the right erector spine muscles with a 3.5 X 2 X 2 cm marginally enhancing cystic lesion at the midline of the subcutaneous region.

Case Discussion

Status post-operative with L5 right fenestrated hemi-laminectomy complicated with:

  •  L5/S1 spondylodiscitis with enhancing epidural abscess formation as well as residual L5/S1 posterior disc extrusion.
  • Operative bed back muscles inflammatory soft tissue with subcutaneous abscess formation.
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Case information

rID: 25795
Case created: 8th Nov 2013
Last edited: 16th Dec 2015
Tag: spine
Inclusion in quiz mode: Included

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