PMC3658226_01
Images 7 months before the onset of pyogenic spondylodiscitis. A) Plain x-ray. Separation of the L4 vertebral arch (small white arrow) and L4/L5 listhesis were noted. B) Plain T2-weighted MRI. The L4/L5 intervertebral disc was degenerated and the height of the intervertebral disc space was decreased (thick white arrow). Separation of ring apophysis of the L4 vertebral body was noted (small black arrow).
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He was diagnosed with L4 lumbar isthmic spondylolisthesis at the age of 28 years and had been receiving conservative treatment with periodic plain x-ray and magnetic resonance imaging (MRI) examinations (Figure 1).
Images on admission. A) Plain x-ray. Although osteosclerosis of the L4 and L5 vertebral bodies was noted (small black arrow), no apparent bone destruction or spur formation was seen in the anterior corner of the vertebral bodies. B) Plain T2-weighted MRI. Signal intensity of the L4/L5 intervertebral disc had apparently changed in comparison with that shown in Figure 1 (thick white arrow). C) Gadolinium-enhanced fat-suppressed T1-weighted MRI. The L4 and L5 vertebral bodies adjacent to the L4/L5 intervertebral disc space were enhanced with gadolinium (small white arrow).
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Plain lumbar x-ray and MRI were performed (Figure 2) and the images were compared with those acquired 7 months previously.
Images 6 months after treatment. A) Plain x-ray. The L4/L5 intervertebral space was lost. B) Plain T2-weighted MRI. The high signal intensity of the L4/L5 intervertebral disc was resolved. C) Gadolinium-enhanced fat-suppressed T1-weighted MRI. Enhancement in the adjacent vertebral bodies remained.
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The marked signal intensity of the L4/L5 intervertebral disc space on MRI had disappeared, but enhancement of the adjacent vertebral bodies remained (Figure 3).