Lumbar Spondylodiscitis

• 50 years old male patient was referred for CTU to assess for renal stones, but after reviewing the CTU images, dedicated history was taken: low back pain, left sciatica, intermittent fever for a month. Further evaluation by postcontrast MRI was done.

– Non contrast CT:

• • No renal stones!
  • Extensive destruction and fragmentation of the L4 vertebral body [sagittal reformat].
  • L3-4 opposing vertebral endplates are indistinct and irregular [sagittal reformat].
  • Paraspinal and epidural soft tissue masses represent paravertebral and epidural phlegmons [axial images].

– Postcontrast MRI: –

•  Sagittal T2: shows destruction of the L3-4 endplates and L4 vertebral body. The L3 and L4 vertebral bodies show increased T2 signal, indicating oedema [orange arrows] {note green arrows of normal end plates}.
• Axial T1 postcontrast: The paravertebral and epidural phlegmonous soft tissue mass enhances following IV contrast highlighting the neural compromise.

1. Dedicated history is a must for proper radiographic evaluation.
2. Proper evaluation of the imaging study is a must regardless of the clinical question to avoid missing the diagnosis.
3. CT scanning is an excellent method for evaluating the bony changes of spondylodiscitis.
4. MR imaging provides a better definition of the epidural extension of the inflammatory process and compression of the spinal cord and dural sac.