Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Worsening Back And Leg Pain


Consult Page

45F hx HIV, IVDU, MRI w/ osteodiscitis p/w intractable back and leg pain

Initial Imaging

Fig. 46.1, Sagittal (A) and axial (B) images of a lumbar spine CT without contrast demonstrate marked collapse of the L4 vertebra with retropulsion of bone within the spinal canal.

Fig. 46.2, Sagittal (A) and axial (B) T1 sequences of a lumbar spine MRI with contrast demonstrates enhancement of the L3 and L4 vertebral bodies and a prominent enhancing epidural collection extending from L3-L5, resulting in thecal sac compression. This is consistent with discitis, osteomyelitis, and an epidural abscess.

Walking Thoughts

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    What is the patient’s neurological exam? Does she have any red flag symptoms (e.g. cauda equina syndrome)?

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    Is the patient hemodynamically stable?

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    Are her inflammatory markers elevated?

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    What is the timeline for the patient’s symptoms?

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    What is the baseline function of the patient?

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    What are the patient’s medical comorbidities (e.g. HIV, endocarditis)?

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    Does the patient take any antiplatelet or anticoagulant medications?

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    Does this patient need urgent or emergent surgery?

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