The patient was operated by me 1997 for PLD L5-S1 and was doing well. The patient then progressed heart failure 2002 and was treated conservatively. I march-2015 heart pacemaker was inserted in India, after what the patient progressed heamaturia was was treated for long time for UTI. The patient then progressed back pain and CT-scan performed 20-November-2016 mild bulge L3-4. The patient then came 09-December-2016 to the clinic walking with complains of back pain. 

On examination, the patient was neurologically free except for midback pain. Considering that it was dangerous to perform MRI of the whole spine, it was decided to perform whole body CT-PET with other investigations. PET-CT-scan was performed 11-December-2016 and showed hyperactive lesion extending from D8, 9 to D10. The patient was sent to oncologic consultation and investigations confirmed the presence of Klebsiella pneumonia sensitive to Gentamicin and Amikacin. He was treated by infectious specialist by Tygacil  50 mg I/V  twice daily.

The patient then came 05-January-2017 telling that he showed dramatic deterioration , in wheelchair with plegia right lower limb and severe weakness left lower limb with analgesia 5 cm above the umbilicus and below both sides.

The patient was sent for new investigations and Chest CT-scan was without proper information, but continuous thin cuts 0.75 mm from D4 down to the mid of D11 with contrast, using ORSVisual application, it was possible to see the supposed to be an epidural pus fulfilling the right side from D8-9-10 with paravertebral abscess reaching the aorta and retropleural cavity both lungs.

Skeletonization of the right side of D8-9-10. Right hemiflavotomy D9-10 and D8-8. No pus is coming out, but severe compression was noted. Complete decompressive laminectomy D9, upper half of D10 and lower half of D8 until the normal epidural fat was noted. There is remnants of epidural fat with inflammatory process. The decompression was performed, so that to preserve stability of the dorsal spine and provide sufficient decompression to the spinal cord. Routine closure of the wound with Ready Vac .

Smooth postoperative recovery. The power of the left leg improved dramatically, but the right lower limb still the same. He was sent to the ward.

The patient having viscous cycle of infection hitting several organs started after heart pacemaker implantation.

CT-scan in not reliable technique for soft tissue detection in the spinal column. It can give disinformation up to 70% as in this case.

Surgical decompression was necessary in this case and the uncertainty of the CT-scan date were considered to put plan A and B.

Adamkiewicz arteries supply the spinal cord from the left side. Here the clinical picture is opposite. Despite that Nootropil and Clexane were started after surgery to rule out vascular compromise.