Post-operative spondylodiscitis and epidural abscess

Case contributed by Mohammad A. ElBeialy
Diagnosis certain

Presentation

Severe back pain and right foot drop with history of back surgery 1 month ago.

Patient Data

Age: 40 years
Gender: Female
  • post-operative state with right L5 fenestrated hemilaminectomy
  • evidence of L5/S1 spondylodiscitis with an 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 endplates with subchondral edematous 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 hemilaminectomy 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

This case demonstrates failed back surgery with L5/S1 spondylodiscitis and enhancing epidural abscess formation as well as residual L5/S1 posterior disc extrusion. An inflammatory soft tissue mass with subcutaneous abscess formation is seen in the operative bed.

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