The patient was operated by me 10-December-2014 for tb pachymeningitis and showed signs of improvement. She came 12-June-2014 walking with aid with slight diffuse weak both lower limbs with power ranging from 5/5 -4/5.with scattered hypalgesia below the umbilicus with preserved sensation of the left leg below the knee. The patient then came to the clinic 17-December-2014 complaining of complete paraplegia the last day with Foley catheter  in wheelchair. She started to dyseasthesia of the left flank 2 months ago which gradually spread to both sides. 20 days ago she got sudden onset loss of sensation of the right leg. The last 3 days got progressing paraplegia with the last movement was noted yesterday of the toes of the left foot.

On examination, the patient has complete paraplegia and analgesia 7 cm above the umbilicus.

MRI of the dorsal spine with contrast and myelography and fibertraking and spectroscopy showing the recent lesions as seen in the below pictures with abscess formation.

The patient was admitted urgently and given Decadron 16 mg I/V 8 h. The patient the next day, showed some movement of both legs, better of the left, for what it is was decided to operate her.

The old incision refreshed and the partially laminectomized D6 was completed to regain normal anatomy. The dura was opened and downward dissection and meylolysis was performed in the midline. The lyodura was seen and included in the incision in the midline. There was another layer under the lyodura, which was a reactionary layer to the lyodura, which was also bisected to obtain maximum release of the spinal cord. According to MRI data aspiration of the upper abscess was succeeded and a thick yellow fluid was obtained. About 3-4 mm sharp incision in the midline was performed to expose the abscess cavity, which was irrigated by saline and part of the capsule with the fluid were sent for through investigations. There is no CSF coming nor from the proximal. nor the lower field of the wound. Intraoperative MRI was done with contrast was done showing the shrinkage of the upper major cavity. The left sided dark colored lesion below the cavity was studied and it was bony hard and it was drilled away until the healthy dura was seen medially. The right lower cavity was aspirated and clear fluid came out and a small incision around 2 mm was performed over it to promote escape of any hidden fluid. The scar was stitched by nylon water-tightly in such way, that further decompression of the spinal cord was achieved. Routine closure of the wound.

Smooth postoperative recovery. The patient immediately after the surgery could feel her left leg and some movement of the feet, better in the left and can with difficulty move the adductors and abductors of the hips.

It was decided before surgery, that if the patient will not improve with Decadron, to abandon the surgery, but she showed some improvement, for what surgery was performed to give the spinal cord the best environment for better healing.

Lyodura inserted in the first surgery generated another layer inside adherent to the pathologic spinal cord.