Post-operative spondylodiscitis and epidural abscess
Severe back pain and right foot drop with history of back surgery 1 month ago.
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·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 right 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.
This case demonstrates failed back surgery with L5/S1 spondylodiscitis and enhancing epidural abscess formation as well as residual L5/S1 posterior disc extrusion. Operative bed back muscles inflammatory soft tissue with subcutaneous abscess formation are noted as well.
- Basu S, Ghosh JD, Malik FH, Tikoo A. Postoperative discitis following single-level lumbar discectomy: Our experience of 17 cases. Basu S, Ghosh JD, Malik FH, Tikoo A. Indian J Orthop. 2012 Jul;46(4):427-33. doi: 10.4103/0019-5413.98831.
- Nasto LA, Colangelo D, Rossi B, Fantoni M, Pola E. Post-operative spondylodiscitis. Eur Rev Med Pharmacol Sci. 2012 Apr;16 Suppl 2:50-7. PMID: 22655483 [PubMed - indexed for MEDLINE]