MRI Finding

• Last unfused vertebra is taken as L5• There is loss of normal signal seen at the vertebral

bodies and bilateral pedicles of T9 and T10 vertebra which are hypointense on T1W images and mixed hyperintense-hypointense on T2W/STIR images. Post contrast, there is enhancement seen.

• The end plates of T9/T10 disc space ( inferior end plate of T9 vertebral body and superior end-plate of T10 vertebral body) are irregular. This finding is best appreciated on sagittal T1W images ( pre and post contrast). There is hyperintense signal seen at the T9/T10 disc space on STIR.

• There is a large peripherally enhancing epidural lesion seen extending from upper border of T9 vertebral body to lower border of T10 vertebral body , likely to be epidural collection/abscess. This epidural collection occupies the anterior and lateral aspects ( left>right) of the spinal canal. The spinal cord is compressed and is displaced posteriorly and to the right, with the narrowest diameter seen at T9/T10 level measuring about 0.7cm (AP) x 0.7cm (W). There is hyperintense signal (on T2W and STIR) seen at the spinal cord at this level but no obvious enhancement seen post contrast

• The epidural collection is also seen extending through bilateral exit neural foramina of T9/T10 level (left>right) and left exit neural foramen of T10/T11 level. The exiting nerve roots (mainly left exiting T9 nerve root) appear compressed. There is small paravertebral collection seen at T9/T10 level (noted on coronal T2W images),larger on the right measuring about 1.0cm (AP) x 0.8cm (W) x 1.9cm(CC).

• At the lumbosacral spine, there is loss of normal intervertebral disc signal noted at L3/L4 level. The L3/L4 disc space is slightly narrowed. There are small posterior disc bulges noted at L2/L3, L3/L4 and L4/L5 levels.

• At L2/L3 level, small posterior disc bulge is abutting theca sac with anteroposterior diameter of spinal canal measures 1.3 cm. No significant exit neural foramina narrowing. No evidence of exiting nerve roots compression seen.

• At L3/L4 level, diffuse posterior sac bulge is abutting theca sac with anteroposterior diameter of spinal canal measures 1.2 cm. Bilateral exit neural foramina appeared narrowed. No evidence of exiting nerve roots compression seen.

• At L4/L5 level,the posterior disc bulge is abutting theca sec with anteroposterior diameter of spinal canal measures 1.2 cm. Bilateral exit neural formina appeared narrowed. No evidence of exiting nerve roots compression seen.

• At cervical spine, there is loss of normal signal of the intervertebral discs. The C3/C4 disc space appears narrowed.

• Posterior disc-osteophyte complexes noted, moat prominently seen at C3/C4 and C6/C7 levels.

• At C3/C4 level, posterior disc-osteophyte complex is compressing theca sac with anteroposterior diameter of spinal canal measures 1.0cm. bilateral exit neural foramina are narrowed (left>right) with possible impingement on bilateral exiting C4 nerve roots.

• At C6/C7 level, posterior disc-osteophyte complex is compressing theca sac with anteroposterior diameter of spinal canal measures 0.9cm. Bilateral exit neural foramina are narrowed with possible impingement on bilateral exiting C7 nerve roots.

• Spinal cord ends at L1/L2 level. Normal cervico-medullary junction. No Chiari malformation.

• No other focal lesion seen at visualized spinal cord.

• The vertebral body heights are preserved• No other focal lesion seen at visualized

vertebral bodies

IMPRESSION

1. The MRI findings at T9-T10 levels are suggestive of spondylodiscitis ( due to TB? Pyogenic) with large epidural abscess collection compressing on the spinal cord. The hyperintense signal seen at the spinal cord at this level could be due to oedema. Small paravertebral collection is also noted.

2. Degenerative disc disease noted at lumbosacral spine at L2/L3, L3/L4 and L4/L5 level. There is no spinal canal stenosis and no evidence of exiting nerve compression seen at these levels.

3. Cervical spondylosis, most prominently at C3/C4 and C6/C7 levels with possible impingement on bilateral exiting C4 and C7 nerve roots.