Spinal epidural abscess: an unusual cause of sciatica.

Abstract

A previously healthy patient was admitted to our hospital because of low back pain and sciatica. For 4 weeks preceding the admission, he had been treated with nonsteroidal antiinflammatory analgetics and bed rest with a clinical diagnosis of lumbar disc herniation. On admission, the patient was subfebrile but developed general symptoms of septic infection by the next day. Computed tomography and magnetic resonance imaging of the lumbar spine revealed a spinal epidural abscess and spondylodiscitis at the L5-S1 level. During an emergency laminotomy, gross pus in abundance was evacuated from the epidural space; microbiological cultures from the pus and blood yielded Staphylococcus aureus. The unique clinical presentation of our patient combined with merely indolent symptoms of infection delayed the correct diagnosis. We are not aware of any similar reports of patients with lower spinal epidural abscess whose primary presentation was sciatic pain.