© 2002 The Fellowship of Postgraduate Medicine
Back pain and systemic compromise
| The first 150 words of the full text of this article appear below. |
The triad of back pain/tenderness, neurological deficits, and systemic illness are highly suggestive of a spinal epidural abscess.
The MRI scan (see p 373) shows a large central disc prolapse at the L4/L5 level. There is also, however, loss of cerebrospinal fluid signal behind the dura from the first lumbar vertebral level caudally, suggestive of a compressive lesion.
Urgent laminectomy was performed. At operation free pus was found in the muscular and fascial layers. There was a large epidural abscess which had caused severe compression of the lumbar thecal sac posteriorly. The epidural space was debrided and irrigated. Cultures of the specimens as well as blood cultures revealed a staphylococcal infection. The patient was started on high dose intravenous flucloxacillin, metronidazole, and gentamicin.
Postoperatively, he was improved neurologically with near normal power in the lower limbs bilaterally and normal sensation including an improvement in his perianal sensation. His subsequent
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- Back pain and systemic compromise
- A A Dyer, K Ashkan, and J Norris
Postgrad. Med. J. 2002 78: 373.[Extract] [Full Text] [PDF]
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