PMC9719436_01
MRI showing the cervical, thoracic, and lumbar spine. (a, b) At the cervical spine, loss of the lordotic angle is demonstrated; destruction of the 6th cervical vertebrae is noted. In C3-C4, there is a collapse of the disc with changes in the signal intensity of the vertebral endplates, which are hyperintense in STIR T2 and isointense in T1 as well as an epidural abscess of 27 x 4.5 mm and encompasses the entire topography of C3 and C4, displacing and compressing the spinal cord. (c, d) At the level of the T12 and L1 vertebral bodies, respectively, in their lower and upper endplates, there is an erosive lesion of 17 x 18 mm involving the intervertebral disc, hyperintense on T2, and hypointense on T1, presenting wall enhancement following contrast. (e) The morphology and height of vertebral bodies T6 and T7 presented morphology alterations due to the destruction of the lower and upper vertebral endplates, respectively, associated with an expansive mass including the intervertebral disc, noted as hypointense on T1 and enhanced on T1 FatSat with gadolinium, and these changes are also observed in the epidural space, surrounding the spinal cord.
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A series of X-rays and MRI were performed (Figure 1), which demonstrated multiple erosive and expansive lesions in the intervertebral discs and endplates in all segments of the spine, the most important being at the cervical region (C3-C7), with destruction and collapse of C6 and an abscess compressing the spinal cord.
Postoperative x-ray of the thoracic spine: (a, b) postoperative changes are visualized at the level of the bony structures by left lateral instrumentation, with an intersomatic cage prosthesis at the level of T6-T7; (c) bone structures with postsurgical changes due to instrumentation in the thoracic spine, observing fixation screws and bar from the body of T4 to the body of T7.
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A chest tube was placed and maintained for the next 72 hours, and broad-spectrum antibiotic therapy was initiated with vancomycin and meropenem awaiting culture results (Figure 2).
(a) Pathology report of T6-T7 intervertebral disc shows extensive fibrosis with mixed inflammatory infiltration, bone and cartilage fragments, and reactive-looking atypia. There was no evidence of granulomas. (b) Cultures isolated Escherichia coli extended-spectrum beta-lactamases (ESBL) and Gram-positive cocci Staphylococcus aureus.
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Rose bengal and GeneXpert MTB/RIF (mycobacterium tuberculosis/rifampin) studies were negative for tuberculosis and brucellosis (Figure 3).
Postoperative x-ray of the cervical spine: (a) surgical material consisting of a 64 mm titanium plate and transcortical locked screws placed from C3 to C7; (b) intersomatic cages at C3-C4 and C6-C7 levels. The amplitude of the intervertebral spaces C2-C3, C4-C5, and C5-C6 is reduced.
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An anterior cervical approach (Smith-Robinson) on the right side was performed, I&D of the prevertebral and medullary canal was carried out and multilevel discectomies were done in levels C3-C4 and C6-C7 and replaced with PEEK cages with matrix, and fusion and stabilization were maintained with an anterior 64 mm titanium plate and locked screws (Figure 4).
Postoperative x-ray of the lumbar spine: (a) transpedicular screws and rod are seen between T12 and L1. The form and height of vertebral bodies are preserved; (b) appropriate amplitude of inter somatic space. A lumbar angle of 57  indicates physiological lordosis.
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Evolution at 24 and 36 hours post-op showed pain decline and increased strength in the lower extremities (Figure 5).