How would you manage a frail but functioning elderly patient with extensive thoracolumbar spinal fusions 4-5 years ago now presenting with copious purulent drainage from L2-L4 whose MRI shows no osteomyelitis or abscess, and who has mild pain but no systemic signs or symptoms of illness?

I would see if there is any way to get a culture (not a swab of the purulence, but maybe a bedside procedure where a deeper sample can be taken without requiring anesthesia). Once I have the culture, I would target the bacteria isolated and give chronic lifelong suppressive oral antibiotic therapy t...

I would recommend referring the patient to the spine surgeon first for a proper evaluation. It’s also important to clarify the source of the drainage, as that is not entirely clear in the current information provided. If imaging is pursued, the MRI should be performed with a metallic artifact reduct...

I agree. More information is needed. Is the purulent fluid really pus? If so, what is it growing? MRIs in the setting of hardware are difficult to interpret. What did the CT scan and the plain films show? If it is a serious infection, the hardware could or will loosen with time. After a couple of ye...