Acute Aggravation of Post Procedural Spondylodiscitis and Paraspinal Abscess without Epidural Space Involvement after Lumbar Percutaneous Epidural Neuroplasty (PEN)

Various complications after Percutaneous epidural neuroplasty (PEN), such as mechanical catheter failure, bleeding, infection, and neurological damage, were reported. A 79 years-old male suffered from spondylodiscitis and paraspinal muscle infection without epidural space involvement after lumbar PEN. The postprocedural infection was difficult to diagnose, because the patient didn’t have common signs and symptoms of infections such as fever, malaise, redness or swelling and hot sense around wound. After 7 weeks of antibiotics treatment, the hospital discharge decision was made, because his lab values and vital sign were almost normal. Most of all, he was symptom free. Early detection of post procedural infection followed by the early administration of antibiotics should be the most important therapeutic strategy for better prognosis. pain unresponsive to other conservative treatments and elevated inflammatory markers . Obtaining bacterial blood cultures and baseline ESR and CRP are required in all patients with suspected spondylodiscitis. Plain radiographs of the spine are not recommended method for the early diagnosis of spondylodiscitis. Erosion of the base and upper plates or increasingly destructive kyphosis can manifest after days or weeks [7]. MRI remains the gold standard for the radiological diagnosis with 92% sensitivity and 96% specificity. MRI findings include decreased signal intensity from disc and adjacent vertebral bodies on T1-weighted images, increased signal intensity on T2-weighted images and loss of endplate definition on T1 weighting. MRI is also useful to measure the spatial extent of the infection or abscess formation. MRI findings of abscess include the presence of a region of high T2 signal, with low T1 signal and without enhancement (usually surrounded by a rim of enhancement)