The patient came to the clinic 30-April-2012 complaining of LBP with right sciatica for 10 days and using walker for a week. The patient is a known diabetic for 15 years. He suffered RTA 15-January-2012 with multiple fractures of the pelvis. On examination at that time he was walking bended with exaggerated scoliotic stance. SLRS was 80 degrees in the right with pain. MRI lumbar spine done 26-April-2012 showing bulge L3-4 and upward mass L4-5 from level. Investigations requested and he came back 04-September-2012 reporting rapid deterioration the last 5 days with agonizing right sciatica. SLRS was 5 degrees with severe pain in the right with weak dorsi and planterflexion right foot 2/5. There was local edema of the right foot. The patient was sent another time for investigations and came 09-September-2012: Bone scan showing several active bone lesions. MRI lumbar spine done 07-September-2012 showing mild retrolisthesis L3-4. mild spondylolisthesis L4-5 with a mass which could be an abscess below L5-S1 level right side. These findings were not seen in the previous investigations. The patient was treated for osteomyelitis and covered with antibiotics. The patient then came 16-October-2012 telling that he is improving and the right sciatica decreased and SLRS was 90 degrees in the right with weak dorsiflexion right foot 3/5 and hypalgesia right L5 territory. The patient kept in antibiotic therapy and came 29-January-2013 complaining of right sciatica with SLRS 80 degrees with pain, weak dorsiflexion -3/5 and planterflexion 4/5 right foot. ESR still 36 mm/h  with MRI lumbar spine performed 28-January-2013 showing showing resolving discitis of L4-5 with persisting mass above the L5-S1 level right side, which mostly an extruded disc from L4-5 with far downward migration. The patient was in baby aspirin, which was stopped 5 days before surgery.

Right L5 hemilaminectomy. The bone is involved with abnormal dark tissue, which was sent for histologic studies. The mass was pushing the dura from the right side and it was removed and sent for histologic verification. The epidural fat was pathologically changed The capsule of the mass was adherent to the dura and the involved dura was kept intact.

Routine closure of the wound. Smooth postoperative recovery.

The patient has osteomyelitis of L4-5 which was treated conservatively. The MRI pictures all the time changing and the persisting mass above the L5-S1 level despite antibiotic treatment for several months force for surgical intervention.

The resect mass and the pathologic bone were sent for histologic verification.