Spondylodiscitis

Case contributed by Hesham Elkhwalka
Diagnosis certain

Presentation

Recent operative interference with postoperative sepsis of unknown source and low back pain.

Patient Data

Age: 80 years
Gender: Male
mri

At L4-5, there is an increased disc signal seen on T2WI with subchondral bone marrow edema of the opposing vertebral endplates. It shows enhancement on the postcontrast series as well as intraspinal extradural enhancing soft tissue seen posterior to L4 down to L5 vertebra with indentation of the thecal sac. No localized fluid collections.

Multilevel Schmorl's nodes are mainly seen at D11-12, L2-3, and L3-4 levels with surrounding bone marrow signal changes and enhancement in the post-contrast series concerning the possibility of multilevel spondylodiscitis of different degrees more at L4-5.

Case Discussion

The case illustrates the important role of MRI in diagnosing and assessing spondylodiscitis with its possible complications like epidural abscess and neural compromise.

STIR is very useful for subtle bone marrow edema. A low signal of bone marrow on T1WI is a very useful sign as well.

Urgent spine team management is crucial to avoid complications. MRI is useful for follow-up of these cases.

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