NEWS

The patient came to the clinic 18-February-2007 complaining of LBP for 2 months with right sciatica which shifted to the left after 2 weeks.

MRI lumbar spine done 16-February-2007 showed a small extrusion of L5-S1 disc.

On examination: the patient was in agonizing pain with scoliotic stance with SLRS 10 degrees both sides. There was weak planterflexion left foot 4/5 and hypalgesia below right L4 root territory.

Considering that, the MRI is not convincing for her clinical data, repeat MRI was requested with LSS-X-ray. It was done and showed a huge migrating mass from L4-5 in the left side upward migrating and far-lateral with involvement of the psoas muscle. Tumorous process or infection were suspected and migrating disc fragment was also considered.

Left sided hemilaminectomy of L4 was performed. The epidural fat is adherent to the dura with thicker consistency, than usual. The left L5 root was identified and followed upward. There is a pocket of puss, which was aspirated by syringe and sent for investigations. Cleaning of the puss pocket from the lateral aspect and the tiny defect in the upper margin of the L4-5 annulus fibrosis was found and a pussy material came from the disc space. The cavities were cleaned meticulously and the wound irrigated with gentamicine. The annulus fibrosis was acceptable and the root became relax, for what attempts to violate the disc space was intentionally abandoned to prevent further spread of the infection to the bony structures.

Routine closure and smooth postoperative recovery and improvement of the power of left foot.

T.B. IgG performed and result released 04-March-2007 and was positive (865.2 U/ml), which confirmed tbc of the pathological process and the patient was kept in anti-tb treatment for the next three years.

The clinical picture was not in compliance with the first performed MRI. Repeat MRI confirmed the presence of another process, which required surgery for verification.

The epidural abscess was evacuated and irrigated meticulously and the disc space was also full of pus, confirming, that discitis was the source of infection.

No attempt was made to violate the intradiscal material, so as to avoid spread of the infection with subsequent osteomyelitis. The annulus fibrosis was acceptable and the left L5 root was relax.

When you are doubt about the radio-morphologic  and clinical data recheck and recheck so as to avoid catastrophic consequences.

Tuberculosis of the spinal column is becoming more frequent incidence in Jordan in the last 2 years. It has different morphologic and clinical picture. The cause could be the politically unstable zone with the use of dirty bombs and the raised radiation in the area, which needs special study from authorized organizations to confirm this speculation.