Epidural for old Discitis?

[jj337]

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A patient was referred today for low back and radicular symptoms for consideration of an epidural by a neurosurgeon. She spontaneously developed discitis 1 year ago (when her symptoms began) and was successfully treated with IV antibiotics and did not require surgery.

Would anyone consider an epidural steroid injection?

 

[Tenesma]

if her c-reactive/sed rate are stone-cold normal, her imaging looks like she has a reasonable cause of radicular symptoms - sure, why not...

 

[PMR 4 MSK]

what's the current dx?

 

[jj337]

Her disc has basically been eroded leaving a calcified mess causing spinal stenosis and neuroforaminal stenosis (sorry, all my attempts at putting the picture on here failed miserably). Her pain is in her back and radiates down both legs. The patient is elderly and is not wanting a large surgery to fix it.

Thanks for your help.

 

[Tenesma]

i have had a few of these over the years.... surprisingly most of these patients just get better with time (even though it looks like somebody dropped a grenade in their back)... a few have done quite well w/ ESI... but again, i would make sure the labs are normal first.

 

[PMR 4 MSK]

If ID gives a go-ahead, I'd do it.