PMC6786395_01
A 48-year-old man (patient 1) with fever and back pain. Sagittal T2 fat-suppressed (a), sagittal T1 fat-suppressed post-contrast (b), axial T1 fat-suppressed post-contrast (c). MR images of the lumbar spine demonstrate a rim enhancing fluid collection in the posterior epidural space (arrowheads) at the L2-L3 level with associated spinal canal stenosis
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Fig1
MRI of the lumbar spine with and without contrast demonstrated a rim enhancing fluid collection in the posterior epidural space at the L2-L3 level with resulting spinal canal stenosis (Fig. 1).
AP (a) and lateral (b) fluoroscopic views of the lumbar spine obtained during percutaneous aspiration procedure for patient 1 demonstrates a midline interlaminar needle approach with the needle tip at the posterior epidural space at the site of the abscess (arrowheads)
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Fig2
Aspiration of the collection was performed under fluoroscopic guidance (Fig. 2) yielding two milliliters of purulent fluid.
A follow up MRI in patient 1 obtained 6 months after presentation. Sagittal T2 fat-suppressed (a) and sagittal T1 fat-suppressed post-contrast MR images of the lumbar spine demonstrate complete resolution of the abscess collection. A small amount of residual enhancing inflammatory tissue is present in the L2-L3 interlaminar space (arrowheads in b)
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Fig3
Follow up MRIs showed decreasing size of the collection with eventual resolution (Fig. 3).
PMC6786395_02
An 81-year-old man (patient 2) with escalating upper back pain and constitutional symptoms. Sagittal T2 fat-suppressed (a), sagittal T1 fat-suppressed post-contrast (b), axial T1 fat-suppressed post-contrast (c), and axial T2 MR images of the thoracic spine demonstrate edema and enhancement centered at the T6 and T7 vertebral bodies compatible with osteomyelitis/discitis (arrow in a and b). There is an elongated, rim-enhancing fluid collection in the posterior epidural space extending across much of the upper thoracic spine (arrowheads in a and b). The axial plane images demonstrate the location of the abscess collection in the midline posterior epidural space (arrowheads in c and d) and show the associated spinal canal stenosis
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Fig4
An MRI of the thoracic spine with and without contrast demonstrated an elongated rim enhancing fluid collection in the posterior epidural space crossing multiple levels in the thoracic spine as well as findings of osteomyelitis and discitis at T6-T7 (Fig. 4).
A lateral fluoroscopic view of the upper thoracic spine obtained during percutaneous aspiration procedure for patient 2 demonstrates a midline interlaminar approach with the needle tip at the posterior epidural space (arrowhead)
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Fig5
His anti-coagulation was reversed, and fluoroscopy-guided aspiration of the posterior epidural collection was performed at the T3-T4 interspinous level targeting the largest portion of the fluid collection posterior to the T3 vertebral body (Fig. 5).