PMC4753335_01
Lateral radiograph of the lumbar spine shows normal L3-L4 disk and normal endplates of L3 and L4.
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Lumbar radiographs did not show any spinal lesions (Figure 1).
MRI scan of the lumbar spine. Sagittal spin-echo T2 weighted MR image (a) and T1 weighted MR image (b); contrast-enhanced T1 weighted image with fat saturation (c) only reveal edematous changes of the vertebral body of L3 with integrity of the L3-L4 disk. Axial Short tau inversion recovery MR image (d) shows vertebral abscess with extension to the paravertebral soft tissues (white arrow).
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There was also an extension to the soft tissues, with an intense oedema visible at the level of the right psoas (Figure 2).
Image during CT-guided aspiration biopsy.
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Because tuberculosis or a bone tumour could not be definitively ruled out, a surgical navigation-assisted aspiration biopsy of the L3 vertebral body was performed using a posterior transpedicular approach (Figure 3).
Lateral radiograph of the lumbar spine 4 days after the surgery shows L3-L4 disk space narrowing with erosion of the inferior endplate of L3 and superior endplate of L4.
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A standard X-ray of the lumbar column was carried out 4 days after surgery and revealed a sudden 30% decrease in the height of the disk space, together with erosions of the adjacent vertebral endplates (Figure 4).
Lateral radiograph of the lumbar spine 2 months after the surgery shows complete collapse of the L3-L4 disk space with marked sclerosis, irregularities, and erosion of the inferior endplate of L3 and superior endplate of L4.
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Nevertheless, 2 months after surgery, a new X-ray revealed a considerable progression of the initial lesion which now included the vertebral body of L4 as well as the L3-L4 disk; there had been complete collapse of the disc and major erosion of the upper vertebral endplate of L4 (Figure 5).