J Korean Soc Radiol.  2014 Dec;71(6):296-303. 10.3348/jksr.2014.71.6.296.

MRI Findings on Iatrogenic Spinal Infection Following Various Pain Management Procedures

• Kim YJ
• Lee JY
• Kim BM
• Kim YM
• Min SH

• KMID: 1801552
• DOI: http://doi.org/10.3348/jksr.2014.71.6.296

Abstract

PURPOSE
The aim of this study was to investigate and report magnetic resonance imaging (MRI) findings of iatrogenic spinal infection (ISI).
MATERIALS AND METHODS
We retrospectively reviewed the clinical and MRI findings on 18 patients diagnosed with ISI. The MRI findings were evaluated for the number of spinal segments showing inflammation in the longitudinal span and affected vertebral bodies and discs, the presence of abscess in the epidural or paravertebral space, paravertebral myositis, and skip lesions.
RESULTS
Among the 18 patients, the range of the longitudinal span of spinal inflammation was 2-11 (mean = 5.84) vertebral segments. 17 of the 18 patients had three or more contiguous vertebral segments. The osteomyelitis and disc destruction was apparent in 77.8% and 66.7% of the patients, and 78% of patients with osteomyelitis showed involvement of one or two vertebrae; 91.7% of patients with disc destruction showed involvement of single disc. The incidence of epidural or paravertebral abscesses, and paravertebral myositis were 88.9%, and 94.4%. There were no spinal skip lesions.
CONCLUSION
MRI findings of those are wide longitudinal span of infection, involvement of no more than one or two vertebral bodies and a single disc, large abscesses, extensive myositis and no skip lesions, can be a useful ISI-diagnostic tool.

MeSH Terms

Abscess
Humans
Iatrogenic Disease
Incidence
Inflammation
Magnetic Resonance Imaging*
Myositis
Osteomyelitis
Pain Management*
Retrospective Studies
Spine

Figure

• 

  Fig. 1 Iatrogenic spinal infection following laser discectomy for L5-S1 with aggravated back pain in 55-year-old man. A. Sagittal fat-suppressed enhanced T1-weighted image shows diffuse enhancement in L5 and S1 vertebral bodies with anterior and posterior subligamentous extensions. Large multiloculated abscesses in the epidural space (arrowheads) extend longitudinally from the L3 to S2. B. Axial fat-suppressed enhanced T1-weighted image at the level of L5-S1 shows large multiloculated abscesses in the epidural space (arrowheads) and paravertebral space (arrows) with thin, smooth walls. In the muscles, inflammatory changes, including psoas, iliacus, multifidus, longissimus, and gluteus, are evident.

• 

  Fig. 2 Iatrogenic spinal infection following epidural anesthesia with febrile illness and back pain in 69-year-old woman. A. Sagittal MR images (T2-weighted, T1-weighted, fat-suppressed contrast-enhanced) show involvement of two vertebral bodies and one disc with disc destruction. Inflammatory changes are shown along the route of injection in the interspinous region of L3-4 (arrow). The longitudinal 10-vertebral-segment span of infection extends vertically from T11 to S3 (not shown here). B. Axial fat-suppressed enhanced T1-weighted image shows extensive myositis in the dorsal (thin arrows) and ventral (thick arrows) paravertebral spaces with multiple abscesses.

• 

  Fig. 3 Iatrogenic spinal infection following acupuncture with aggravated pain and fever in 74-year-old woman. A. Sagittal MR images (T2-weighted, T1-weighted, fat-suppressed contrast-enhanced) show involvement of three vertebral bodies (L4, L5, and S1, arrows) without involvement of intervening intervertebral discs. The longitudinal 11-vertebral-segment extends vertically from T10 to S3 (not shown here). Image distortion by metal artifacts in the L4 and L5 vertebrae from previous, eight-years-earlier spinal surgery is shown. B. Axial fat-suppressed enhanced T1-weighted image at the level of L4-5 shows large paravertebral abscess (thick arrow) and pyomyositis in the dorsal paravertebral space (thin arrows).

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  Fig. 4 Iatrogenic spinal infection following acupuncture with aggravated pain in 48-year-old woman. Sagittal MR images (T2-weighted, T1-weighted, fat-suppressed contrast-enhanced) show non-involvement of vertebral body or intervening intervertebral disc despite large epidural (arrowheads) and paravertebral (arrow) abscesses and wide longitudinal span of infection. The L5 body shows a chronic compression fracture and normal marrow signal intensity.

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