200 Section - An Uncommon Cause of Spinal Cord Injury: Osteomyelitis-Induced Acute T10 ASIA A Paraplegia

A 70-year-old male with medical history of moderate L1-S1 spinal stenosis presented to the emergency department with acute bilateral lower extremity weakness, without trauma. Physical examination revealed complete loss of motor and sensory function below the T10 level, consistent with an ASIA A classification of spinal cord injury (SCI). Lumbar MRI showed discitis and osteomyelitis at T10-L1, with associated compressive myelopathy. Despite the absence of systemic signs of infection, the patient exhibited a steady decline in motor function, suggesting significant spinal cord involvement.

Discussions:

While trauma remains the leading cause of SCI, accounts for approximately 2.5–3% of all SCI cases. This case highlights a non-traumatic SCI— infection-related myelopathy secondary to infectious process, contrasting with the more common traumatic causes. Notable infectious causes include vertebral osteomyelitis and spinal epidural abscesses, which can lead to compressive myelopathy if undiagnosed or untreated. The patient's pre-existing spinal stenosis is a known risk factor, as it can predispose individuals to infections. Osteomyelitis, though rare, is a serious cause of non-traumatic SCI, and in this case, it led to vertebral infection, compromising the spinal cord and causing acute paraplegia. Early imaging—particularly MRI—is essential for diagnosing these conditions, especially when clinical signs are subtle, as delayed diagnosis can lead to irreversible neurological damage.

Conclusions:

This case highlights the complexities of spinal pathology in elderly patients with pre-existing degenerative conditions. Osteomyelitis is a critical cause of non-traumatic spinal cord injury and can lead to rapid neurologic decline, even in the absence of systemic signs of infection. The absence of inflammatory markers or fever should not delay consideration of spinal infection when acute deficits are present. Prompt recognition and treatment are key to preventing severe neurological impairment and long-term disability.