Presentation
Middle aged diabetic with acute on chronic neck pain.
Patient Data
Normal appearances - vertebral and disc spaces normal.
No bony destruction.
Normal pre-vertebral soft tissue thickness.
3/12 later films repeated for neck pain on admission to hospital.
C4-C5 disc space narrowing.
Destruction of neighboring endplates, especially the C5 vertebral body.
Enlarged pre-vertebral soft tissue thickening.
Reduced bone marrow signal in C4 and C5.
High signal in the C4-C5 disc space.
Pre-vertebral collection from C3-C5.
Vertebral body destruction at C4-C5 with associated prevertebral soft tissue swelling.
1 mth later after surgical fixation.
Internal fixation from C4-C6.
The pre-vertebral soft tissue remains thickened.
Case Discussion
An 'time-lapse' case of cervical osteomyelitis from normal to post fixation films.
An associated pre-vertebral collection is evident, which is responsible for the important lesson in pre-vertebral soft tissue widening on the presentation plain film.