Abstract
Pain having relief was successfully achieved in two patients with severe back pain. These patients were finally diagnosed as pyogenic spondylitis.
Case 1: A 54-yr-old man visited our clinic complaining of NSAIDs-resistant low back pain that had developed after mowing. Physical examination revealed no neurologic deficit and negative SLR test. The X-ray films of lumbar spine showed no significant abnormality. Several epidural blocks relieved the pain. A moderate systemic inflammation was implied by ESR 73mm/h and CRP 6.1mg/ dl. Magnetic resonance imaging (MRI) showing osteolysis in L4 vertebral body suggested pyogenic spondylitis. Case 2: A 66-yr-old woman with a six-month history of increasing pain of the chest and back was admitted to our hospital because of unsatisfactory results from several prior analgesics. Physical examination on admission disclosed kyphosis with tenderness and no neurologic dysfunction except for bilateral hyperactivity of the patellar tendon reflex. Metastatic tumor of the thoracic spine was suspected because of osteolytic lesions in TV 5-6 on MRI scan performed prior to admission. A slight systemic inflammation was implied by ESR 82mm/h and CRP 0.1mg/dl. A bone scintigraphy showing slightly increased activity in TV 5-6 did not support the previous diagnosis. Osteolysis with a spotty pattern demonstrated by tomogram of the thoracic spine gave the diagnosis of pyogenic spondylitis. The chest and back pain were successfully controlled by continuous epidural block and bed rest. Both patients recovered without neurologic sequelae. Antibiotics were given in case 1, but not in case 2. In conclusion, epidural block might be a therapeutic option for severe pain from pyogenic spondylitis in which neuraxial block is considered to be a contraindication.
