Presentation
1-week history of acute on chronic lower back pain.
Patient Data
Abnormal low T1 signal and high T2 signal is visualized at the level of L4 and L5 vertebral bodies with significant high signal in the disc at this level. Abnormal tissue is visualized anterior and posterior to the vertebral bodies at these levels representing discitis osteomyelitis.
Findings on axial images are as follow:
L1-L2, unremarkable
L2-L3, unremarkable
L3-L4, disc bulge, facet hypertrophy, mild canal stenosis.
L4-L5, disc bulge, prominent posterior to the disc and vertebral bodies, mild canal stenosis, mild to moderate bilateral neural foramina narrowing.
L5-S1, annular fissure, central and left paracentral protrusion measuring approximately 1.5-5.6 cm, no canal stenosis or neural foramina narrowing. Fat graft Conus ends at the level of L1 vertebral body. Mild disc space narrowing at the level of L4-L5 and L5-S1
Case Discussion
This represents a case of discitis osteomyelitis. The patient is a 60-year-old female who presented to the emergency department with back pain and lower extremity weakness. Laboratory evaluation revealed elevated ESR and CRP. MRI of the spine confirmed osteomyelitis. The patient was given IV antibiotics and analgesics. Upon discharge, she was advised to modify his daily activities.