Concluded Case

A case of back pain for evaluation.

New case. 78 yr ,M, Admitted on 28th july with back pain since april this yr. Progressive difficulty in walking since june but with mild help he could walk. The back pain is in the lower back,initially while getting up on lying down position ang getting up from sitting. Once he got up, he was able to walk till recently. A month after the onset of back pain ,he developed radiating pain in the legs ,intermittently , sneezing coughing aggravate the pain and pain mostly in the back of thigh radiation to both lower limbs up to the lateral toes. 1st week of july, he developed difficulty in passing urine with fever and was evaluated by the Nephrologist and UTI was diagnosed and started on antibiotics. He took antibiotic for 15 days. Known DM,on insulin ; known hypertensive ,on urimax for BPH On exam Bp140/ 86 mmhg ,local tenderness in the lumbosacral area with out any local deformity. Motor system gr 4/5 power in the lower limbs both knee jerks hypoactive,ankle jerks absent with dulling of sensation L5 S1 both sides.with support he is able to walk. Blood report TC 12800/ cumm,80 % polymorphs. Hb10.3 gr. ESR 42 mm/ hr,CRP 18. Apart from raised Blood sugar ,no other biochemical abnormalities noted. MRI lS spine done and he had undergone surgery and is discharging today. What abnormality in the MRI -LS spine with possible diagnosis?

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Conclusion.Discussion.Mri findings with diagnosis. * Diffuse marrow edema in L 5 vertebral body and S1 verebra,with mild extension of marrow edema to Rt pedicle of L5 vertebra. I'll defind anterior paravertebral collections extending from the level of L 5 vertebral inferior end plate. * Inflammatory changes tracking along the presacral region up to coccyx level. Altered signal in the anterior epidural space at L5 S1 level ,causing focal mild central spinal canal stenosis. * No evidence of vertebral marrow edema / paravertebral collection in the rest of spine, but osteoarthritis changes noted. Imp: Features are suggestive of Spondulodiscitis with anterior epidural abscess. Surgery done by our spinal surgeon. Open decompression L5 S1; bilateral iliolumbar fixation,L5 S1 A1; L5 S1 Rt sided soft interbody fusion,left sided posterior fusion L4 S2 inder GA. Biopsy : Section shows degenerative disc material with extensive neutrophils infiltration and necrotic debri. No granuloma. Final Diagnosis. PYOGENIC SPONDYLODISCITIS L5S1 WITH SEVERE BONY DISTRICTION CIRCUMFERENTIAL EPIDURAL ABSCESS. " Unable to complete the answer in the space provided" and hence writing separately.

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#L2 lumber vertebra with radiculopathy. Lower motor neurone radiculopathy. Surgery already done.proper care and restricted mobility will make him prognosis better. Antibiotics analgesic inflammatory and vit d3 and calcium citrate and b complex make bone stronger.

L2 compression fracture needs posteriour stabilization With pedicle screws and decompression irrespective of age As in this age if u make bed ridden he may develop bed sore sk better to operate and make him mobile for speedy recovery

Already done the surgery by our spinal surgeon. Discharging today. Thanks for the answer. I WII UPDATE LATER

Agree@Dr. Yashavardhan T M Sir Ji

Thank you doctor

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Awc fracture L2 In the absence of trauma,need evaluation CBC esr Urine bence Jones protein Serum protein electrophoresis PSA

Thanks for the answer.Kindly recheck the films. Look for L5 S1 .I am sure ,you are able to pick the abnormality

Thank Curofy and all Dictors who answered the case.

Writing separate conclusion due to lack of space.kindly go through

May fracture 'lumber spine Lumber rediculopathy.....

Multiple disc disorder, lumbar canal stenosis, cauda equina synd

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