Case contributed by Dr Bahman Rasuli


Sudden onset of lower back pain and lower limbs paresthesia.

Patient Data

Age: 55 years
Gender: Male

Abnormal bone marrow signal is seen at the L3 and L4 vertebral bodies displaying T1 hypo- and T2 hyperintense signals. This is associated with irregular opposing endplates, narrowing of L3/4 disc with central T2 hyperintense focus lacking a central nuclear cleft.

Intraspinal extradural linear soft tissue component extending from the superior endplate of L3 to the inferior endplate of L4 compressing the anterior thecal aspect causing to spondylotic canal stenosis and derangement of the nerve roots also are seen.

Bilateral paravertebral soft tissue components also are seen infiltrating the medial aspect of psoas muscles bilaterally.

Spondylotic canal stenosis also is noted at the L4-L5 level in the background of left paracentral disc protrusion with thecal sac impression as well as facet joints and ligamentum flavum hypertrophy.

Disc bulging is seen at the L5-S1 level. 

Hemangioma is noted at D11 vertebrae.

Case Discussion

This patient was referred with the history of sudden onset lower back pain and lower limbs paresthesia with suspicious for acute disc herniation.

Lumbar MRI was done and imaging findings revealed abnormal signal at the L3-L4 disc space and endplates of the L3 and L4 vertebrae with suspicion for spondylodiscitis. It should be mentioned that spondylodiscitis can progress to psoas abscess formation and residual deformity. MRI is the modality of choice for reliable diagnosis and for differentiation from similar diseases.

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