0:01

Here's a patient with a thoracic myelopathy. T2-weighted,

0:05

T1-weighted,

0:06

and STIR imaging shows abnormal signal intensity in the

0:10

vertebral bodies on either side of a bright signal

0:15

intensity disc. On the T1-weighted scan,

0:17

we see low signal intensity from the bone edema.

0:21

And on the STIR image,

0:23

we see that very bright signal intensity disc,

0:25

as well as the high signal intensity on the vertebral

0:28

bodies on either side. In this situation,

0:31

we also are identifying an element of displacement

0:35

of the spinal cord posteriorly.

0:37

And it looks as if there is a collection in the anterior

0:41

epidural space within the spinal canal.

0:45

Post-gadolinium enhanced scans would be useful in identifying

0:48

whether or not we have a phlegmon versus an abscess.

0:51

The phlegmon would show solid enhancement.

0:53

The abscess would show a ring of absence of enhancement.

0:56

So let's compare this. On the post contrast scan,

1:00

we see the necrotic disc showing some

1:04

enhancement on the anterior aspect.

1:07

We see the diffuse enhancement of both vertebral bodies, as well

1:12

as in the anterior space deep to the

1:15

anterior longitudinal ligament.

1:17

There is enhancement in the anterior

1:21

epidural space in the spinal canal,

1:23

but it really doesn't show the same type of ring enhancement

1:26

that we would worry about with regard to an abscess that a

1:30

surgeon would want to go in to operate on. On the axial scans,

1:35

post contrast, if we come down to the area,

1:37

we have a lot of motion artifact.

1:39

Let's see whether we got anything better over here. We repeat it.

1:43

And here you can see that there is indentation on the thecal sac

1:47

by what is solid tissue, more likely to be

1:52

termed a phlegmon than an abscess.

1:55

There is diffuse enhancement in the paraspinal soft tissues

1:59

as well from this inflammatory process.

2:02

This is pretty clearly discitis and osteomyelitis

2:06

with an anterior epidural intraspinal phlegmon.