Presentation
Trauma
Patient Data
Marked abnormality at the C5-6 level with fragmentation and destruction of the endplates resulting in focal kyphosis. There is a distraction of the facets joints and interspinous space. Mildly retropulsion fragment. Dense material noted in the epidural space, mainly anteriorly, suggestive of epidural collection causing severe mass effect on the thecal sac. This epidural thickening extends from at least C4-C7. Severe prevertebral soft tissue thickening, extending from the skull base to the upper thoracic spine.
There is a periosteal reaction along the anterior vertebral cortex of C4 and C6.
The above findings were in keeping with subacute spondylodiscitis, as confirmed later on MRI.
Case Discussion
Spondylodiskitis is osteomyelitis of the vertebral bodies and intervertebral disk secondary to an infectious process. Hematogenous spread of pathogens is the most common route of seeding. It leads to erosions, destruction, and compression fractures with resulting spinal instability, deformity, and risk of cord compression. The infection can breach the bone and spread into surrounding soft tissues, causing paravertebral or psoas abscesses, and track into the central canal, forming an epidural abscess.
The predominant pyogenic pathogen is S. Aureus with a distant focus of infection being identified in almost 50% of cases. Hematogenous bacterial spondylodiscitis affects preferentially the lumbar spine, followed by the thoracic then cervical spine.
Although CT is good at delineating bone abnormalities including early endplate erosions, MR is considered the modality of choice for assessment of spondylodiscitis and its associated complications.
Case co-author: Rehana Jaffer, MD, FRCPC