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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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