Back pain with tenderness and fever.
MRI of the lumbar spine
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Altered matrix of the opposing parts of L1 and L2 vertebral bodies displaying T1 hypo- and T2 hyperintense signals. This is associated with irregular (eroded) opposing endplates, narrowing of L1/2 disc with central T2 hyperintense focus lacking a central nuclear cleft.
Intraspinal extradural spindle-shaped soft tissue component extending from the superior endplate of L1 to the inferior endplate of L2 compressing the anterior thecal aspect and bilateral paravertebral soft tissue components also seen infiltrating the medial aspect of psoas muscle bilaterally.
In contrast-enhanced T1WI, the involved parts of the vertebral bodies, the intervertebral disc and the involved extraosseous components showed homogeneous enhancement.
Spondylodiskitis most commonly affects the lumbar spine. It can progress to psoas abscess formation and residual deformity. MRI is the modality of choice for reliable diagnosis and for differentiation from similar diseases. Important diagnostic signs include a T2 hyperintense signal at the intervertebral disc, endplate erosions, epidural and psoas abscesses, and enhancement of the disc, endplates, and the involved perivertebral soft tissues.