PMC10032522_01
Preoperative T2-weighted MRI sequences obtained from an extensive SEA in a 70-year-old man. Midsagittal views showing the SEA (A,D,G). Axial imaging at C-3 (B), C-5/6 (C), T-6/7 (E), T-10/11 (F), L-1/2 (H) and L-2/3 (I) showing extensive ventral collection. Mixed-high signals (white arrow) on T2-weighted imaging indicate the spondylodiscitis at the L3/4 segment (G).
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F1
Magnetic resonance imaging (MRI) confirmed extensive SEA from C2 to L4 and a spondylodiscitis at the L3/4 segment (Figure 1).
Intraoperative photographs: pale-yellow purulent fluid was drained from lumber spine.
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F2
A 3-mm-diameter ventricular drainage tube was gently and gradually guided cephalad along the ventral side, and the operating table was tilted (reverse Trendelenburg) for drainage (Figure 2).
Postoperative T2-weighted MRI sequences of the first surgery (A-I) and second surgery (J-R). Comparing with pre-operation, the midsagittal view (A,D,G) illustrated slightly reduction of epidural abscess at cervical, thoracic, and lumbar levels. Mixed-high signals (white arrows) on T2-weighted imaging indicate that the lumbar incision infection was aggravated (G). The midsagittal view (J,M,P) and axial view (K,L,N,O,Q,R) showed the absence of epidural abscess, and the compression has significantly relieved after the second surgery.
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F3
However, mixed-high signals appeared in the lumbar incision on T2-weighted imaging, indicating aggravation of local infection (Figures 3A-I). Re-examination of the spinal MRI showed that the abscess in the spinal canal had almost disappeared, and the compression was significantly relieved (Figures 3J-R).
Schema of antibiotics application and time course for C-reactive protein (CRP), white blood cell (WBC), and erythrocyte sedimentation rate (ESR). The horizontal axis indicates the days of hospitalization, and the vertical axis indicates the levels of CRP, WBC, and ESR. The two-way arrows below the graph indicate the intravenous antibiotic treatment.
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F4
The schema of antibiotics application and time course for CRP, WBC, and ESR are shown in Figure 4.