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Korean J Pain. 2005 Jun;18(1):69-73. Korean. Case Report.
Kim DH , Hwang DS .
Department of Anesthesiology, College of Medicine, Dankook University, Cheonan, Korea.

This report describes a case of spinal nerve root compression due to an acute inflammatory granuloma after lumbar surgery. A 39 year-old man with a history of increasing back pain with a 3-week duration was diagnosed with a herniated intervertebral disc (HIVD). The diagnosis of a HIVD was confirmed by magnetic resonance imaging (MRI) with indications for surgery. A discectomy and a partial laminectomy was performed and the symptoms were alleviated immediately after surgery for a five-day period. However, a slowly progressing pain was subsequently noted along a different dermatome. There was no pain relief despite the patient being given pharmacological treatments, combined with an epidural steroid injection. The follow up MRI images showed severe compression of the nerve roots by a epidural lesion. Another procedure was performed 17 days after the initial operation. The lesion responsible for the compression of the nerve roots was found to be an acute inflammatory granuloma. The pain was relieved after the second procedure and there were no other symptoms or neurological problems. This case is remarkable in that a granuloma formed relatively quickly and grew to such a size that it was able to severely compress the surrounding nerve roots.

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