PMC8664247_01
(A) Initial MRI image. Note the important prevertebral mass with disc and adjacent bone involvement typical of fungal spondylodiscitis. In addition, an epidural mass was seen with spinal cord compression. Positive SPECT-TC and gamma scan showing a pathological uptake where spondylodiscitis was suspected. (B) MRI and CT were taken a few days before surgery. The results reaffirmed the necessity of surgery in this case, given the inefficiency of medical treatment. Note the worsening of the Kyphosis curve, the damaged bone, and the epidural mass. Blue arrow, spondylodiscitis destruction; Orange asterisk, prevertebral mass infection; Purple asterisk, epidural mass infection.
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F1
A single-photon emission computerized tomography (SPECT) and gamma scan confirmed the highly suggestive diagnosis of spondylodiscitis (Figure 1A). Surgery was performed due to a lack of improvement in serial MRIs and blood inflammatory markers (Figure 1B).
(A) Intraoperative images. Pathological bone in the affected vertebrae was drilled with a high-speed drill. Once the vertebrectomy was done, an expandable cage was fitted inside. (B) Coronal, axial, and sagittal CT views after surgery. No complications related to the approach or osteosynthesis materials were identified. (C) MRI images were taken after surgery. Note the evacuation of the epidural mass and the decompression done on the spinal cord in the axial views. Green arrow, osteosynthesis material (expandable titanium cage with a lateral fixation plate).
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F2
Once the thoracotomy was done, the right lung was collapsed, and the vertebrae were reached via a transpleural approach (Figure 2A). After 8 months of follow-up, the infection seemed to have resolved, the patient had fully recovered, and he returned to his normal life (Figures 2B,C).