Ankylosing Spondylitis with Pseudoarthrosis and Chronic SDH

Findings:

The sagittal T1 weighted image demonstrates multilevel spinal ankylosis extending from T5 through T10-11 and at T12-L1. A remote healed fracture is present at the T8 level which extends horizontally through the vertebral body. There is T2 hyperintensity within the T3-4 disc space. There is desiccation and height loss of the T4-5 disk space. At the T11 level, there is a broad fluid signal cleft within the vertebral body with extensive chronic erosion of T11. The surrounding marrow of T11 is low signal on all sequences due to sclerosis, with no definite marrow edema signal identified on T2 fat saturated sagittal imaging. Remote compression fractures are identified at L1 and L4. A large T1 hyperintense subdural fluid collection extends from T11 through the terminal thecal sac with ventral and dorsal components, this collection demonstrates T2 hyperintensity. Multiple nerve roots are displaced peripherally at the level of the fluid collection. An additional CSF signal ventral subdural fluid collection extends from T4 through T8. Additional components of complex fluid collections surround the distal spinal cord from T8-T11 which are best seen on the sagittal T1 sequence. The upper thoracic cord is draped over kyphosis.

Discussion/Differential Diagnosis:

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