Postoperative Spondylodiscitis and Epidural Abscess Becoming Visible on Magnetic Resonance Imaging before Positive Laboratory Tests

Year 2015, , 97 - 101, 09.10.2015

Aysin Pourbagher Sermin Tok , Hülya Aslan

https://doi.org/10.17826/cutf.57738

Abstract

Post operative disc space infection is relatively uncommon. The incidence of postoperative disc space infection is 0.21 %-3.6 % in association with all vertebral surgical procedures. Surgery causes a variety of neuroendocrine and metabolic responses which generally results in immunosupression. Clinical results of immunosupression include delayed wound healing and septic complications. In this article, we report magnetic resonance imaging findings of a case with spondylodiscitis and spinal epidural abscess in which the imaging findings were apparent before the infection and inflammation related laboratory findings laboratory findings become positive. She has a history of surgery due to lumbar herniated disc a month. She was complaining of back and left leg pain. We performed contrast-enhanced MR imaging. MR imaging showed post operative changes at level L5 and S1. There was contrast enhancement at the level of the surgical gap in the posterior paravertebral muscles. MR imaging may help to differentiate postoperative spondylodiscitis and epidural abscess from early postoperative changes even before the laboratory tests appearing positive. In our case, surgery induced immunosupression may cause the infection and inflammation related laboratory findings being within normal limits at the beginning.

Keywords

Spinal epidural abscess; Spondylodiscitis; Magnetic Resonance Imaging

Laboratuvar Testleri Pozitif Olmadan Magnetik Rezonans Görüntüleme ile Tanı Konulan Postoperatif Spondilodiskitis ve Epidural Abse

Abstract

Postoperatif disk mesafesi enfeksiyonu nisbeten nadir bir durumdur. Tüm vertebral cerrahi girişimler ile ilişkili postoperatif disk enfeksiyonu insidansı % 0.21-% 3.6 arasındadır. Cerrahi genellikle immünsüpresyon ile sonuçlanan çeşitli nöroendokrin ve metabolic yanıtlara neden olmaktadır. Bu makalede, laboratuar bulguları pozitif olmadan, manyetik rezonans görüntüleme bulguları görünür hale gelen spondilodiskit ve spinal epidural abseli olgu sunulmuştur. Olgunun bir ay once lumbal herniye disk nedeniyle operasyon öyküsü vardı. Sırt ve sol bacak ağrısından şikayet ediyordu. Kontrastlı MR L5 ve S1 düzeyinde operasyona sekonder değişiklikleri gösterdi. Cerrahi lojunda posterior paravertebral kaslarda contrast tutulumu vardı.MR görüntüleme bulguları, laboratuvar testleri pozitif olömadan once postoperative spondilodiskitis ve epidural abseyi eken dönem postoperative değişikliklerden ayırmamızı sağlayabilir. Olgumuzda, cerrahiye bağlı immunsupresyon nedeniyle infeksiyon ve inflamasyonun laboratuar bulguları başlangıçta normal limitlerde olabilir

Keywords

Spinal epidural abse; Spondilodiskit; Manyetik Rezonans Görüntüleme

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