76-year-old male with history of C4-T1 cervical fusion presents with open wound and exposed spinous process of T1. Evaluate for osteomyelitis. There are postsurgical changes of posterior fusion from C4 to T2 and anterior cervical fusion from C5 to C7 with interbody bone grafts at C5-C6 and C6-7. A fragment of an old pedicle screw is again seen at the right T1 level as identified on the prior CT. There is evidence of wide laminectomies at the C2-3 to C6-7 levels. There is straightening of the cervical spine, which may be due to fusion.  Susceptibility artifact related to hardware limits evaluation. There is a soft tissue defect involving the posterior neck with exposure of the T1 spinous process and surrounding soft tissue edema and enhancement. Foci of susceptibility in the soft tissue adjacent to the T1 spinous process may represent foci of air related to wound dehiscence. There is no evidence of a drainable fluid collection. There is increased T2 and decreased T1 signal with enhancement of the spinous process of T1, which is suspicious for osteomyelitis (best seen on axial series 14, image 17). There is no evidence of discitis, abscess, or epidural collection. There is no evidence of central spinal canal stenosis or cord signal abnormality. There is mild left neuroforaminal stenosis at C3-4 and mild-to-moderate left neuroforaminal stenosis at C4-5.
Bone marrow signal abnormality involving the T1 spinous process is suspicious for osteomyelitis. There are surrounding inflammatory changes in the adjacent soft tissues. There are suspected subcutaneous foci of air which may be related to the open wound. There is no appreciable drainable fluid collection in the paraspinous soft tissues, with susceptibility artifact from hardware slightly limiting evaluation. No findings to suggest discitis or epidural abscess.