PMC4429750_01
Cervicothoracic spinal MRI on admission indicated an epidural abscess with iso-high intensity on T1WI (B) and low intensity on T2WI (A) at C5-6. The lumbar T2WI image showed no lesion (C).
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A magnetic resonance imaging (MRI) scan did not indicate any thoracolumbar lesion (Fig. 1C) and suggested an epidural abscess at C5-6 (Fig. 1A and B).
Cervicothoracic MRI on day 3 and 18 showed an epidural abscess with iso-intensity on T1WI (B), low intensity on T2WI (A), and no enhancement (C) at C5-6. The epidural fluid exhibited iso-intensity on T1WI, and spinal cord compression was noted at C4-7. The C5-6 vertebral body exhibited iso-intensity on T1WI and high intensity on T2WI and T1Gd.
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On day 3 in our hospital, MRI findings revealed a decrease in epidural fluid collection (Fig. 2A-C). An MRI scan showed that the epidural fluid compressed the spinal cord at C4-7 (Fig. 2D-F).
Cervical MRI at day 1, 3, and 18 on T1WI and T2WI at C6-7. The right intradural mass exhibiting low intensity on T1WI and T2WI is shown (yellow arrow).. Abbreviations: R, right; L, left.
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MRI also showed a right intradural mass spreading to the epidural space at C6-7 (Fig. 3). The right intradural mass was still present at C6-7 (Fig. 3).
Intraoperative view. The left side in the picture represents the rostral side. The upper side in the picture is the right side. The right dorsal dura mater at C6-7 has a yellowish surface.
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The surface of the C6-7 dura mater was yellowish in color, indicating the infectious changes (Fig. 4).
Postoperative cervicothoracic MRI. (A) T1Gd images. The enhanced area and fluid collection were reduced. Preoperative and postoperative roentgenogram. (B) Preoperative lateral, (C) postoperative lateral, and (D) postoperative frontal views. Anterior stabilization of C4-7 and posterior reconstruction and stabilization of C4-T1. An expandable cage was implanted in the C4-7 intervertebral space. Posterior lateral mass screws (C4-C6) and pedicle screws (C7/T1) were implanted.
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A cervical roentgenogram revealed the destructive changes in the C5-6 vertebral body and a kyphotic alignment (Fig. 5B). Intraoperative and MRI findings revealed destruction of the anterior and posterior columns of spinal support elements (Fig. 5A). Thus, we performed debridement of all necrotic bone and soft tissues, anterior stabilization of C4-7, and posterior reconstruction and stabilization of C4-T1 (Fig. 5C and D).