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Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit  neurosurgery.tv

 

18-SEPTEMBER-2006  AHMAD HELMY AL-KAYYED  60 YEARS  FULMINANT OSTEOMYELITIS BOTH L4 AND L5 BODIES WITH DISCITIS L4-5 AND L5-S1.
 

The patient came to the clinic 04-September-2006 complaining of agonizing LBP with bilateral sciatica for three months. He was unable to walk without aid and he had exaggerated scoliotic stance. SLRS was 45 degrees in both sides with weak dorsi and planterflexion both feet. MRI lumbar spine performed 15-June-2006 showed mild PLD L4-5, not conforming with his clinical picture, for what a new MRI with contrast of the lumbar spine was requested.

MRI performed 05-September-2006 showed massive discitis of L4-5 and L5-S1 with osteomyelitis of L4 and L3 bodies. Bone scan  showed increased uptake of the tracer at the pathologic site and the right 8th rib, which explained by an old trauma. Bence-Jones proteins were negative and lab investigations showed an inflammatory process, but blood for CXS was negative.

The patient was admitted 17-September-2006 and targocid with gentamycin were started with pain-killers. The next day, using percutanous discectomy kit, a pus was evacuated from the intradiscal space of L4-5 and fragments of inflamed disc material was sent for all possible investigations to rule out malignancy, tbc, fungal, or other pathologies.

Comments:

1.  Comparing the MRI performed at the start of the complains and 2 months later, showed dramatic changes, which mostly due to osteomyelitis.  This case make it possible, that discitis could in some cases lead to PLD with subsequent postoperative osteomyelitis and discitis. Usually the surgeon blame himself for that, but this case confirm, that discitis with subsequent escalation of symptoms could undergo without surgical interference.

The final result of investigations was active tbc of the spine and the patient was started with antitbc drugs accordingly.

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[2006] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved