PMC9581127_01
(A) MRI T1-weighted image shows a long strip of isointense lesions on the dorsal side of the spinal cord in the C1-C7 spinal canal. Also see C5/6 intervertebral disc herniation, and the corresponding dura and spinal cord are compressed. (B) T2-weighted image shows hyperintensity of the lesion. (C) T1-enhanced image showed annular enhancement of the lesion, no obvious internal enhancement, and spinal cord compression at the corresponding level. (D) Axial T1-enhanced image showed a large range of irregular non-enhanced areas in the soft tissue of the right posterior side of the cervical spine, and a ring-enhancing lesion in the right posterior part of the spinal cord in the spinal canal, with no obvious internal enhancement. (E) Coronal T1-enhanced image shows a slightly hypointense lesion on the right side of the spinal cord in the cervical spinal canal and (F) a honeycomb-like non-enhancing area in the soft tissue on the right side of the spinal canal.
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F1
MRI of the cervical and thoracic vertebrae was immediately performed, showing abnormal signal shadow of dorsal spinal cord in the spinal canal at C1-C7 level, inflammatory lesions with the possibility of local abscess formation, posterior herniation of the C5/6 disc, and compression of the surrounding dura and spinal cord (Figure 1).
(A) during the operation, a fistula was seen in the right posterior side of the spinal canal, connecting the paravertebral abscess and the spinal epidural abscess.The arrow points to the location of the fistula. (B) After opening the lamina, a large amount of pus was seen in the spinal canal, and the pus was mainly located in the back of the spinal cord and the right side of the spinal cord. The arrow points to the pus on the side of the spinal cord. (C) The surgical incision and drainage tube for the spinal abscess are shown on the left, and the surgical incision and drainage tube for the paravertebral soft tissue abscess in the neck are shown on the left.
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F2
A large amount of dark yellow epidural pus spilled when the C3-C5 lamina was opened (Figure 2).
(A) microscopic examination of the sample tissue with HE staining revealed fibrous adipose tissue, in which a large number of acute and chronic inflammatory cell infiltrates with abscess formation, and vascular dilatation and hyperemia were observed. Picture was taken at 100 magnification. (B) T1-weighted image of the cervical spine 21 days after the operation showed that the abscess signal in the spinal canal disappeared. (C) T2-weighted image of the cervical spine 21 days after the operation.
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F3
Bacterial culture and drug sensitivity test showed Staphylococcus aureus (susceptible to vancomycin, levofloxacin and ceftriaxone), and pathological results showed inflammatory reactions (Figure 3). MRI of the cervical spine 21 days after the operation showed that the abscess signal in the spinal canal disappeared completely (Figure 3).