Abstract
Although spinal infections are rare, their morbidity and mortality are high in case of delay in diagnosis. Imaging methods have an important place in early diagnosis. Magnetic resonance imaging is the examination with the highest sensitivity and specificity among radiological methods. Plain radiographs, computed tomography and nuclear medicine examinations may help diagnosis. Radiological findings of spinal infection may be confused with Modic type 1 degenaration, Schmorl nodule, fracture, metastasis, ankylosing spondilitis, SAPHO syndrome and neuropathic degenarative changes. When the diagnosis is made late, abscess may develop in the paravertebral muscles, epidural and subdural areas. Tuberculosis, brucellosis and fungal infections progress slowly and insidiously. Therefore, patients’ admission to the hospital may be delayed. Imaging methods should be used without delay in patients with suppressed immune systems and those living in endemic areas. In this review, we aim to provide information about how to interpret radiological findings in the early diagnosis, follow-up and differential diagnosis of spinal infections.
Keywords: Spinal infection, pyogenic spondylodiscitis, epidural abcess, tuberculous spondylodiscitis, radiology, magnetic resonance imaging
References
Ledermann HP, Schweitzer ME, Morrison WB, Carrino JA. MR imaging findings in spinal infections: rules or myths?Radiology. 2003; 228: 506-14.
Hong SH, Choi JY, Lee JW, Kim NR, Choi JA, Kang HS. MR imaging assessment of the spine: infection or an imitation?Radiographics. 2009; 29: 599-612.
Moore SL, Rafii M. Imaging of musculoskeletal and spinal tuberculosis.Radiol Clin North Am. 2001; 39: 329-42.
Dhodapkar MM, Patel T, Rubio DR. Imaging in spinal infections: current status and future directions.N Am Spine Soc J. 2023; 16: 100275.
Maiuri F, Iaconetta G, Gallicchio B, Manto A, Briganti F. Spondylodiscitis. Clinical and magnetic resonance diagnosis.Spine (Phila Pa 1976).1997; 22: 1741-6.
Van Tassel P. Magnetic resonance imaging of spinal infections.Top Magn Reson Imaging. 1994; 6: 69-81.
Go JL, Rothman S, Prosper A, Silbergleit R, Lerner A. Spine infections.Neuroimaging Clin N Am. ; 22: 755-72.
Resnik D, Kransdorf MJ. Osteomyelitis, septic arthritis and soft tissue infection: axial skeleton. In: Resnick D, editor. Diagnosis of bone and joint disorders. 4th ed. Philadelphia: Saunders; 2002. p.2481-2509.
Mylona E, Samarkos M, Kakalou E, Fanourgiakis P, Skoutelis A. Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics.Semin Arthritis Rheum. 2009; 39: 10-7.
Tins BJ, Cassar-Pullicino VN, Lalam RK. Magnetic resonance imaging of spinal infection.Top Magn Reson Imaging.2007; 18: 213-22.
Diehn FE. Imaging of spine infection.Radiol Clin North Am.2012; 50: 777-98.
Wiley AM, Trueta J. The vascular anatomy of the spine and its relationship to pyogenic vertebral osteomyelitis.J Bone Joint Surg Br.1959; 41-B: 796-809.
Mazzie JP, Brooks MK, Gnerre J. Imaging and management of postoperative spine infection.Neuroimaging Clin N Am. 2014; 24: 365-74.
Bonakdar-pour A, Gaines VD. The radiology of osteomyelitis.Orthop Clin North Am.1983; 14: 21-37.
Rothman SL. The diagnosis of infections of the spine by modern imaging techniques.Orthop Clin North Am. 1996; 27: 15-31.
Talbott JF, Shah VN, Uzelac A, Narvid J, Dumont RA, Chin CT, et al. Imaging-based approach to extradural infections of the spine.Semin Ultrasound CT MR. 2018; 39: 570-86.
Gratz S, Dörner J, Oestmann JW, Opitz M, Behr T, Meller J, et al. 67Ga-citrate and 99Tcm-MDP for estimating the severity of vertebral osteomyelitis.Nucl Med Commun. 2000; 21: 111-20.
Raghavan M, Lazzeri E, Palestro CJ. Imaging of spondylodiscitis.Semin Nucl Med. 2018; 48: 131-47.
Kartamihardja AHS, Kurniawati Y, Gunawan R. Diagnostic value of 99mTc-ethambutol scintigraphy in tuberculosis: compared to microbiological and histopathological tests.Ann Nucl Med. 2018; 32: 60-8.
Yokota H, Tali ET. Spinal infections.Neuroimaging Clin N Am. 2023;33:167-83.
Frel M, Białecki J, Wieczorek J, Paluch Ł, Dąbrowska-Thing A, Walecki J. Magnetic resonance imaging in differentatial diagnosis of pyogenic spondylodiscitis and tuberculous spondylodiscitis.Pol J Radiol.2017; 82: 71-87.
Ozaksoy D, Yücesoy K, Yücesoy M, Kovanlikaya I, Yüce A, Naderi S. Brucellar spondylitis: MRI findings.Eur Spine J. 2001; 10: 529-33.
Williams RL, Fukui MB, Meltzer CC, Swarnkar A, Johnson DW, Welch W. Fungal spinal osteomyelitis in the immunocompromised patient: MR findings in three cases.AJNR Am J Neuroradiol. 1999; 20: 381-5.
Son JM, Jee WH, Jung CK, Kim SI, Ha KY. Aspergillus spondylitis involving the cervico-thoraco-lumbar spine in an immunocompromised patient: a case report.Korean J Radiol. 2007; 8: 448-51.
Yuh WT, Zachar CK, Barloon TJ, Sato Y, Sickels WJ, Hawes DR. Vertebral compression fractures: distinction between benign and malignant causes with MR imaging.Radiology. 1989; 172: 215-8.
Yeom JA, Lee IS, Suh HB, Song YS, Song JW. Magnetic resonance imaging findings of early spondylodiscitis: interpretive challenges and atypical findings. Korean J Radiol. 2016; 17: 565-80.
Boutin RD, Resnick D. The SAPHO syndrome: an evolving concept for unifying several idiopathic disorders of bone and skin.AJR Am J Roentgenol. 1998; 170: 585-91.
Toussirot E, Dupond JL, Wendling D. Spondylodiscitis in SAPHO syndrome. A series of eight cases.Ann Rheum Dis. 1997; 56: 52-8.
Park YH, Taylor JA, Szollar SM, Resnick D. Imaging findings in spinal neuroarthropathy.Spine (Phila Pa 1976).1994; 19: 1499-504.
