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.
Kenalog in blood - Derby et al. "Size and aggregation of corticosteroids used for epidural injections"