Comparison of pyogenic spondylitis and tuberculous spondylitis

Abstract

Pyogenic spondylitis and tuberculous spondylitis are common causes of spinal infection. It is difficult to differentiate tuberculous spondylitis and pyogenic spondylitis clinically and radiologically. Recently magnetic resonance imaging has been reported to be beneficial for early diagnosis and differential diagnosis of the spondylitis, and is being used extensively for diagnosis. However, the diagnosis must be considered in combination with corresponding changes in clinical manifestations, radiological findings, blood and tissue cultures and histopathological findings. Conservative treatments, including antimicrobial medications, are started initially. Surgical treatments, which include anterior or posterior approach, single-stage or two-stage surgery, with or without instrumentation, may be performed as indicated.

Keywords: Differential diagnosis; Pyogenic spondylitis; Tuberous spondylitis.

Fig. 1

Magnetic resonance imaging findings of tuberculous spondylitis in a 76-year-old woman. (A) T1 weighted sagittal image demonstrates hypointense signal in T12-L2 vertebral bodies with epidural mass and subligamentous spread from T12 to L2. (B) T2 weighted sagittal image shows heterogeneously hyperintense signal. (C) Contrast enhanced T1 sagittal weighted image shows heterogenous enhancement of T12-L2 vertebral bodies. (D) Axial contrast enhanced T1 weighted image shows paraspinal abnormal enhancement and paraspinal abscess-like lesion with peripheral well-enhanced thick wall.

Fig. 2

Magnetic resonance imaging findings of pyogenic spondylitis in a 73-year-old man. (A) Sagittal T1 weighted image shows diffusely decreased signal intensity in T11-T12 vertebral bodies. (B) On sagittal T2 weighted image, T11 and T12 vertebral bodies are isointense to adjacent normal vertebrae. (C) Sagittal contrast enhanced T1 weighted image shows diffuse heterogenous enhancement. Abscess is present in T11-T12 disc space extending to vertebral bodies. (D) Axial contrast enhanced T1 weighted image shows thick and irregular rim enhancement of paraspinal abscess.