case_images: PMC9924703_01
case_images: MRI with and without contrast of the lumbar spine.. Sagittal T1 with contrast (A), sagittal T2 (B), sagittal T2 STIR (C), axial T1 with contrast (D), and axial T2 (E) at the level of interest. MRI shows enhancing collection at L2-3 ventral and to the left of the thecal sac, causing circumferential compression. The collection measures 38 mm (cranial-caudal) by 14 mm (anterior-posterior) by 13 mm (lateral). The inferior L2 vertebral body, L2-3 intervertebral disc, and superior L3 vertebral body demonstrate heterogenous contrast enhancement.. STIR: short TI inversion recovery
case_images: cureus-0015-00000033668-i01.jpg
case_images: PMC9924703_01_cureus-0015-00000033668-i01.jpg
case_images: FIG1
case_images: MRI with and without contrast of the lumbar spine demonstrated an enhancing collection at L2-3 appearing to originate ventral and to the left of the thecal sac and causing severe canal stenosis (Figure 1). As a result, the decision was made to proceed with L2-3 laminectomy with the evacuation and washout of a suspected epidural abscess (Figure 1).
case_images: CT (A and B) and MRI (C, D, and E) of the lumbar spine taken during first rehospitalization.. CT scans include sagittal T1 without contrast (top left) and coronal T1 without contrast (top middle). CT in both sagittal (A) and coronal (B) views demonstrates increased sclerosis of the endplates at the L2-3 level with endplate erosion and vertebral body destruction prominent along the inferior aspect of the L2 vertebral body consistent with a discitis and acute infection. MRI shows an epidural soft tissue lesion seen at the level of L2-3 and seen clearly on sagittal T2 (C), which also enhances on T1 post contrast (D and E) and enhances and compresses the canal and nerve roots. Also appreciated is a 5.6 x 3.8 soft tissue enhancing mass present posteriorly at this level slightly inferior to the epidural abscess, which contains multiple internal septations (E).
case_images: cureus-0015-00000033668-i02.jpg
case_images: PMC9924703_01_cureus-0015-00000033668-i02.jpg
case_images: FIG2
case_images: MRI demonstrated the recurrence of the epidural abscess, along with a new right psoas abscess (Figure 2).
case_images: CT (A, B, and C) and MRI (D and E) of the lumbar spine taken during second rehospitalization.. Significantly worsening kyphotic deformity with worsening L3 body destruction and now with retrolisthesis of L2 on L3 appreciated on both CT (A, B, and C) and MRI (D and E). MRI additionally demonstrates the extension of the abscess from the vertebral body to the canal resulting in moderate spinal canal stenosis and severe bilateral neural foraminal stenosis (D and E).
case_images: cureus-0015-00000033668-i03.jpg
case_images: PMC9924703_01_cureus-0015-00000033668-i03.jpg
case_images: FIG3
case_images: The L1 and L4 set screws were final tightened but not at L2 and L3 to permit distraction and compression during the placement of the lateral interbody (Figure 3).