“ Involvement of two vertebrae and the intervertebral disc (i.e. one spinal segment) is nearly pathognomic of spondylodiscitis. Infection be...
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Involvement of two vertebrae and the intervertebral disc (i.e. one spinal segment) is nearly pathognomic of spondylodiscitis. Infection begins by haematogenous seeding or direct spread posttrauma/surgery/adjacent sepsis. A total of 85% of infections are in the lumbar and thoracic regions; up to 90% are due to Staphylococcus aureus. Back pain of gradual onset is the most common presenting feature.
MRI
• T1 (pre- and post-contrast), fat-saturated T2 or STIR sequences are most useful.
• Hypointense vertebral body signal on T1.
• Loss of endplate definition.
• Increased disc signal intensity on T2.
• Contrast enhancement of the disc and endplates.
• Enhancement of the epidural and paraspinal tissues.
• Homogeneous enhancement suggests phlegmon, ring enhancement favours abscess.
• Scoliosis/kyphosis as vertebral collapse ensues.
• Prominent bone sclerosis.
• Skip lesions and multiple levels (>3) suggest tuberculous discitis.
• Disc space narrowing
• Endplate irregularity/definition
• Paraspinal calcification suggests a tuberculosis (TB) spondylodiscitis
Discitis. Lateral lumbar spine x-ray demonstrating disc space narrowing and endplate destruction/loss of definition at L3/4 (white arrow).
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