The patient came to the clinic 22-April-2018 complaining of LBP and both flanks more the left pain for 45 days. The patient was treated for brucellosis 18 months ago. There is no sciatica. MRI lumbar spine bad quality performed 22-March-2018 showing extruded disc L5-S1. The patient is a known diabetic with arterial hypertension. 

On examination, the patient is limping with scoliotic stance. Using crutches the last month. SLRS was 80 degrees in both sides. There was weak dorsiflexion right foot 4/5, left foot -4/5.

The patient was sent for investigation and MRI lumbar spine performed 22-April-2018 showing discitis of L2-3 with huge abscess in the left psoas muscle extending from L2 down to L4. The extruded disc of L5-S1 is an ld one and calcified. ESR was 65 mm/h, CRP 97 mg/L. The patient was advised to undergo conservative treatment and to be re-evaluated after one moth. The patient then came 28-April-2018 urging for surgery and was admitted the same day.

In laminectomy position, under G.A. a wide trocar was directed toward L3-4 lateral process, where the most prominent collection according to the performed MRI. No pus coming out. A  4 cm wound was created and sharp dissection carried out the expose the left lateral proccessi of L3 and 4. The ligament between the 2 proccessi was opened and no pus, nor mass was found. The patient was sent for MRI to see what is going on. MRI performed and the approach was under the pus cavity, which regressed over the last 4 days. The dissection was carried out cranial and the lateral process of L3 was sharply dissected and lateral to its superior corner, the abscess start to come out. Around 25 ml of pus was collected and sent to all investigations. A ready Vac drain 12 was inserted to the collapsed cavity.

Smooth postoperative recovery. The power of both feet normalized. He was sent to the ward. The next days the patient claiming dramatic improvement of his condition.

The patient has infection of unknown cause, and Zinnat could decrease the abscess during the 4 days.

In the future such case it is preferable to repeat MRI immediately before surgery to avoid such confusion.

Intraoperative MRI is a strong tool, which can direct the surgeon in such cases to decide what exactly is going on and decide the next steps in the surgery.