Presentation
Had surgery 3 months ago for L4-L5 disc prolapse, presented with severe low black pain radiating to the right lower limb, fever. Laboratory investigations revealed: WBC count at 13,700/mm3, with high CRP level.
Patient Data
There is a lobulated epidural structure at L4-L5 level of right lateral location, extending through the adjacent exit foramen, and posterior L4-L5 disc space, with mass effect on the ipsilateral L5 nerve root as well as the thecal sac. It appears of low signal intensity on T1WI, inhomogeneous high signal intensity on T2WI with peripheral enhancement and restricted diffusion on DWI/ADC. The posterior half of L5 vertebral body and its right pedicle show low signal on T1WI, high signal on T2WI with enhancement, indicating spondylitis. There is an irregularity with the erosion of the adjacent posterior vertebral wall of L5. The right paravertebral muscles show an edematous infiltration with enhancement on postcontrast sequences (myositis).
Case Discussion
The patient was operated the next day, and a small infected surgical sponge was removed.
Infection of the surgical site following spinal surgery are rare but considered as a serious complication, cause of increased morbidity. Usually due to infected spinal instrumentation, rarely attributed to an infection of the retained surgical sponges as in this case. The diagnosis is usually suspected on clinical presentation and laboratory investigations, and confirmed by the imaging modalities.
Additional contributor: R Bouguelaa, MD.
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