Medical History Male patient, 56 years old, presented a severe acute exacerbation of chronic low back pain (present for 3 months), with irradiation to left inguinal region. He denies previous trauma, but underwent total knee arthroplasty (TKA) for treatment of osteoarthritis thirty days ago. On examination: Poor oral hygiene. Painful palpation of left paravertebral lumbar region. No neurological deficits. Right knee with moderate joint heat and effusion, with no fistula. Laboratory tests: CRP: 232 mg/L, ESR: 115 mm/h and leukocytosis with left shift. Imaging studies of lumbar spine were performed (Figures 1, 2 and 3). Figure 1: Lumbar spine radiograph, profile incidence.Figure 2: Tomography of lumbar spine, without intravenous contrast. A. Axial cut, level L3-L4.Figure 3: Magnetic resonance, sagittal cut, in T2. Question:Based on clinical data and imaging tests, what is the most likely sequence of events in this case? Periodontal disease > Knee prosthesis infection > Spondylodiscitis Periodontal disease > Spondylodiscitis > Knee prosthesis infection Knee prosthesis infection > Spondylodiscitis > Greater left psoas muscle abscess Knee prosthesis infection > Greater left psoas muscle abscess > Spondylodiscitis Time is Up! Time's up
