PMC3065056_01
Saggittal thoracolumbar spine MRI with STIR (short T1/tau inversion recovery): day 1 (a) and day 11 (b). Serial MRI images of the thoracic and sacral spinal cord from hospitalization day 1 (a) and day 11 (b) using STIR (short T1/tau inversion recovery) sequences. Panel A shows a 12 x 3 cm multiloculated abscess of the right paraspinal musculature in the L2-L5 region, and subtle enhancement of the L3-L4 transverse processes, consistent with osteomyelitis. There is no epidural abscess. The MRI in (b) shows extensive rim enhancement of the epidural column and severe anterior compression of the spinal cord.
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fig1
There was dural enhancement at L3 and L4 but no epidural abscess (Figure 1(a)), and his cervical spine was unremarkable (Figure 2(a)). A repeat MRI performed at this time revealed an extensive rim-enhancing epidural collection posterior to the spinal cord and cauda equina that extended from the level of the first cervical vertebra to the sacrum, with continuous and severe cord compression against the anterior spinal column (Figures 1(b) and 2(b)) consistent with a large spinal epidural abscess.
Saggittal T1 cervical spine MRI: day 1 (a) and day 11 (b). Serial MRI images of the cervical spine from hospitalization day 1 (a) and day 11 (b). (a) shows a relatively normal cervical spine with only mild degenerative disc protrusion and mild canal stenosis at C6-C7. (b) shows epidural enhancement and marked anterior compression of the spinal cord beginning at the level of C1 and continuing caudally.
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fig2
There was dural enhancement at L3 and L4 but no epidural abscess (Figure 1(a)), and his cervical spine was unremarkable (Figure 2(a)).