Spondylodiscitis L5-S1 with epidural abscesses

Case contributed by Dr Maxime St-Amant

Presentation

Lower back pain for more than one month.

Patient Data

Age: 50
Gender: Male

Slight narrowing of the L5-S1 intervertebral space without other significant abnormality. 

The patient represented one month later with fever. 

X-ray

One month later

The second spine x-ray, done one month later, shows a small exacerbation of the intervertebral narrowing at L5-S1 with slight sclerosis of the vertebral plateau.

MRI was suggested because of the symptoms (fever and back pain) to rule out spondylodiscitis. This diagnosis was suggested on the basis of plain films (progressive narrowing of the intervertebral disc space). MRI was performed same day as the second x-ray. 

MRI confirms the diagnosis of spondylodiscitis. Also, there are three small epidural abscesses; two located behind L5-S1 in the anterior thecal sac and one located posteriorly behind S2.

Indeed, there is an important narrowing of the L5-S1 intervertebral space with vertebral plateau edema, focal enhancement (and enhancement of adjacent soft tissue) following gadolinium administration.

The vertebral bodies also appear diffusely hypo-intense, although still slightly hyper-intense in comparison to intervertebral discs. This finding is probably related to medullary reconversion in responses to the infectious process. Other findings include a central discal herniation at L4-L5.

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Case information

rID: 19266
Case created: 21st Aug 2012
Last edited: 9th Aug 2016
Tag: spine
Inclusion in quiz mode: Included

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