Spinal discitis/osteomyelitis

Case contributed by A.Prof Frank Gaillard

Presentation

History of caecal cancer and recent febrile neutropenia, no source found. Ongoing fevers and new severe back pain, lower lumbar.

Patient Data

Age: 75 years
Gender: Female
Modality: MRI

Foci of high STIR signal and contrast enhancement within the L2/3 disc, together with abnormal low T1 signal, high STIR signal and contrast enhancement of the L2 and L3 vertebral bodies adjacent to the L2/3 intervertebral disc. No epidural abscess. Abnormal enhancing tissue within the adjacent psoas muscle at those levels is present. On the right. a small region (7mm) of high T2/low T1 with only peripheral enhancement is present consistent with a small abscess.

The conus terminates normally at the L1 level, with normal signal characteristics.

Vertebral body height and alignment are within normal limits. No significant spinal canal or intervertebral foraminal stenosis. T12 haemangioma.

Conclusion: In this clinical context (fever, back pain) features are those of L2/3 discitis-osteomyelitis without epidural abscess, and with a tiny right sided paraspinal abscess.

Modality: Nuclear medicine

RADIOPHARMACEUTICAL: 99mTc MDP, 800 MBq

A whole body bone scan was performed, including SPECT CT of the lumbosacral spine. 

Blood flow and blood pool imaging revealed mildly increased vascularity in the coccyx and at L2-L3. 

Delayed imaging demonstrates moderately increased bone tracer concentration seen involving the endplates of L2-L3 vertebral bodies, especially on the right adjacent to the disc. 

A further focus of moderately increased tracer is seen in the right 10th rib laterally and the coccyx most likely represent unrecognised fractures. 

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Case Information

rID: 33938
Case created: 30th Jan 2015
Last edited: 29th Mar 2017
System: Spine
Inclusion in quiz mode: Included

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