Variant 3: Suspected spine infection (such as epidural abscess or discitis osteomyelitis), with new neurologic deficit or cauda equina syndrome. Initial imaging. The presence of a new neurologic deficit or cauda equina syndrome may be due to spinal cord or cauda equina compromise by either epidural abscess, displaced infected vertebral and/or disc material, or infection-mediated spinal malalignment or instability. The incidence of epidural abscess is 2.5 to 3 per 10,000 hospital admissions [14,60]. Although neurologic deficits are seen in 10% to 15% of cases of spine infection, these clinical situations require immediate imaging attention because the imaging evaluation helps to determine the location and extent of the spinal canal compromise [3,60]. The body regions covered in this clinical scenario are the cervical, thoracic, and lumbar spine. These body regions might be evaluated separately or in combination as guided by physical examination findings, patient history, and other available information. Suspected Spine Infection CT Spine Area of Interest Noncontrast and contrast-enhanced CT have an overall low sensitivity (6%) for the identification of epidural abscess [33]. Gross spinal cord compression with compromise of the spinal canal (>50% canal narrowing) may be seen in more advanced cases of spine infection [71]. The addition of IV contrast increases the conspicuity of paraspinal soft tissue abnormalities, such as inflammation or abscess that may be caused by infection. In those cases in which a contrast-enhanced CT is to be performed, it is not necessary or useful to perform a noncontrast-enhanced CT first, because this latter examination does not add more diagnostic information. The sensitivity and specificity of CT for spine infection is 79% and 100%, respectively [33]. CT with multiplanar reformations is often used in surgical planning and follow-up [8].
Suspected Spine Infection PCAs. Variant 3: Suspected spine infection (such as epidural abscess or discitis osteomyelitis), with new neurologic deficit or cauda equina syndrome. Initial imaging. The presence of a new neurologic deficit or cauda equina syndrome may be due to spinal cord or cauda equina compromise by either epidural abscess, displaced infected vertebral and/or disc material, or infection-mediated spinal malalignment or instability. The incidence of epidural abscess is 2.5 to 3 per 10,000 hospital admissions [14,60]. Although neurologic deficits are seen in 10% to 15% of cases of spine infection, these clinical situations require immediate imaging attention because the imaging evaluation helps to determine the location and extent of the spinal canal compromise [3,60]. The body regions covered in this clinical scenario are the cervical, thoracic, and lumbar spine. These body regions might be evaluated separately or in combination as guided by physical examination findings, patient history, and other available information. Suspected Spine Infection CT Spine Area of Interest Noncontrast and contrast-enhanced CT have an overall low sensitivity (6%) for the identification of epidural abscess [33]. Gross spinal cord compression with compromise of the spinal canal (>50% canal narrowing) may be seen in more advanced cases of spine infection [71]. The addition of IV contrast increases the conspicuity of paraspinal soft tissue abnormalities, such as inflammation or abscess that may be caused by infection. In those cases in which a contrast-enhanced CT is to be performed, it is not necessary or useful to perform a noncontrast-enhanced CT first, because this latter examination does not add more diagnostic information. The sensitivity and specificity of CT for spine infection is 79% and 100%, respectively [33]. CT with multiplanar reformations is often used in surgical planning and follow-up [8].