7
Spinal Trauma

A 17-year-old boy was in a motor vehicle accident and became paraplegic. He had a cervical fusion for stabilization and then extensive rehabilitation. During his rehabilitation course, a urinary tract infection seeded his epidural space, causing a discitis and osteomyelitis (Fig. 7-1). This was treated with prolonged intravenous antibiotics. A couple years after his accident, he began experiencing worsening hand weakness, paresthesias, and hyperhidrosis.

FIGURE 7-1 Lumbar MRI with L3-L4 osteomyelitis and discitis.

Radiologic Findings

Magnetic resonance imaging (MRI) of the cervical spine shows an intramedullary fluid-filled cavity at C7-T1 (Fig. 7-2). There is also some metallic artifact seen around the posterior elements from the patient’s previous fusion.

Diagnosis

Posttraumatic syrinx