Spondylodiscitis - post-operative

Case contributed by Mohamed Mahmoud Elthokapy

Presentation

Diabetic patient underwent lumbar spinal surgery 3 weeks ago. Presented with severe low back pain, fever, wound infection and pus discharging from the wound.

Patient Data

Age: 50 years
Gender: Female

Narrowed L3/4 and L4/5 intervertebral discs associated with vertebral endplates erosions and subchondral extensive marrow edema seen involving L3 and L4 vertebral bodies. Associated large intra-spinal osseous poorly defined heterogenous cystic lesion involving disc space and extending along L4 vertebral body mainly of low T1 and high T2 with marginal enhancement measuring about 4 x 4 cm, moreover extra-spinal (pre and paravertebral) well-defined bilateral swellings are seen abutting psoas muscle, being larger on the left side with muscle edema

Moreover, thick well-defined intraspinal extradural cystic collection and soft tissue thickening of similar signal intensity are seen opposite L3/4 disc level and extending cranially opposite L3 vertebral body compressing the theca and both exit neural foramina.

L3/4 laminectomy with enhancing granulation tissue compressing the posterior thecal aspect as well as showing small cystic loculations.

Case Discussion

This patient was diagnosed with post-surgery spondylodiscitis associated with local spinal/paraspinal abscess at the L3/4 and to less extent L4/5 levels as described. The patient underwent another operation to evacuate the collection and the patient has had clinical improvement since. 

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