Postoperative back pain

A 59-year-old woman underwent an Ivor-Lewis oesphagogastrectomy after being diagnosed with a lower oesophageal carcinoma. At operation the tumour was noted to be mobile and noninvasive. Histology of the resected specimen showed a poorly differentiated adenocarcinoma extending to the serosa, with clear resection margins and no lymph node involvement. Her postoperative course was unremarkable aside from a superficial wound infection in the thoracotomy scar which developed on day seven. A wound swab grew Staphylococcus aureus and the infection was successfully treated with a 7-day course of oral cephradine. Five weeks later the patient sustained a minor fall and presented complaining of mild lower back ache. Examination was unremarkable. A lumbar spine X-ray was performed (figure 1). Four weeks later the patient noticed a small, tender swelling over the T12 / L1 area. A gibbus then developed at this site and over the next two weeks the swelling expanded to 20 × 15 cm. Magnetic resonance imaging (MRI) of the thoracolumbar spine was performed (figure2).   Figure 1 Lateral X-ray of …