The patient came
the operating room with history of 7 months of LBP after surgery for
pilonidal sinus 24-April-2006. The patient continued to complain
of agonizing LBP with bilateral sciatica more in the right. MRI of
the lumbar spine performed 1 week ago showed osteomyelitic changes
of L3 and L4 bodies with discitis of L3-4. There was no soft tissue
component and destruction of the endplates causing moderated
compression of the dural sac.
On examination: the patient had weak
dorsiflexion both feet more pronounced in the right foot.
Percutanous discectomy of L3-4 guided with image-intensifier was
performed and the bony and disc material was sent for
1. Infection could be spread by bloodstream after the surgery
for pilonidal sinus. Investigations and biopsy must be done to rule
out presence of other ethiological factors.
2. Most of the articles concerning pilonidal sinus
discuss the recurrence, but such blood stream spread of the lesion
to the vertebral bodies rarely mentioned.