Select the most likely diagnosis for a 63 years old male patient with back pain & paraparesis.
- Metastasis
- Discitis & osteomyelitis
- Discitis, osteomyelitis & epidural abscess
- Degenerative compression fracture
- Schmorl nodes
Answer
Congratulations to those who had selected option C (discitis, osteomyelitis & epidural abscess). The disc space is disrupted, adjacent endplates are deformed and the adjacent vertebral bodies show contrast enhancement. There is a contrast-enhancing extradural collection compressing the spinal cord (epidural abscess).
The metastatic lesion typically involves the bodies and spares discs. It also usually involves posterior elements of the spine as well, which is not always true for infection.
Degenerative compression fractures do not show contrast enhancement.
Schmorl nodes are protrusions of the cartilage of the intervertebral disc through the vertebral body endplate and into the adjacent vertebra. The disc height is usually preserved and in some cases reduced, but the body doesn’t enhance.