The clinical history, physical examination, and imaging is consistent with extensive destruction of the lumbar spine extending over three vertebral segments with associated epidural abcess necessitating surgical decompression and fusion. An epidural abscess may present rapidly with neurological compromise. Prognosis improves with prompt decompression, but only 18% of patients with frank abscess and 23% of patients with paralysis completely recover after decompression.
Hadjipavlou et al report in their Level 4 study that leukocyte counts were elevated in % of spondylodiscitis cases. The erythrocyte sedimentation rate was elevated in all cases of epidural abscess.
The article by Harrington et al states that the surgical indications for an epidural abcess include: unsuccessful antibiotic treatment after 6 weeks, vertebral deformity or instability, neurological deficit, MRI showing > 50% compression of thecal sac, and depressed host immune response.
Illustration A shows radiographs following anterior debridement, corpectomy, fibular strut grafting, and Kaneda instrumentation.
I had three injections all of which worked for a few days to two weeks then stopped. The excruciating pain returned and only Vicoden 5 mg 3-4 times a day controlled the pain. Vicoden at that dose is the lowest dose prescribed. it worked perfectly for several years and doctors refused to prescribed opioids for fear of losing their license. My sister recently died of throat cancer and she complained constantly of pain. She died with unrelieved pain. As a cancer patient she was prescribed Morphine 2 mg. every 6 hours. That is beyond ridiculous but keeps our doctor’s license safe. Our doctors are violating their Hippocratic oath – Do No Harm. They had added a caveat “except when the government is breathing down your neck. Then the patient be damned. I am glad this helped you Randy. I don’t know your clinical status but I am sure it differs from mine. Do you have severe and crippling arthritis?