PMC8087468_01
Images of administration on the 5th day of hospitalization. X-ray (a, b) sagittal T2 short tau inversion recovery (T2-STIR) MRI (c), axial L4/5 T2-weighted MRI (d).
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MRI showed a slight amount of fluid had collected at the left L4/5 facet joint; these findings are considered to be associated with degenerative changes (Figure 1).
MRI images on the 5th day of hospitalization. Sagittal view (a and b) and axial view at L4/5 (c) of T2-STIR MRI showing an abscess from the facet joint to the paravertebral muscle (a, c) and epidural abscess (arrows).
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The repeated MRI revealed continuous fluid from the facet joint to paravertebral muscles and epidural space (Figure 2).
X-ray during left L4/5 facet puncture.
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We performed a diagnostic facet joint puncture on the left L4/5 (Figure 3) on the 8th day; the culture tests detected MSSA and were negative for calcium pyrophosphate and uric acid crystals.
MRI image at two weeks after surgery. Sagittal view of T2-STIR MRI showing bone edema of the left L5 pedicle and L4 and 5 vertebral bodies around the pedicle (arrows).
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Two weeks after surgery, we took a follow-up MRI, which showed signal changes at the left L5 pedicle and L4 and 5 vertebral bodies around the pedicle, which suggested osteomyelitis (Figure 4).