Spinal Infections

Abstract

Spinal infections represent a group of rare conditions affecting vertebral bodies, intervertebral discs, paraspinal soft tissues, epidural space, meninges, and spinal cord. The causal factors, clinical presentations, and imaging features are a challenge because the difficulty to differentiate them from other conditions, such as degenerative and inflammatory disorders and spinal neoplasm. They require early recognition because delay diagnosis, imaging, and intervention may have devastating consequences especially in children and the elderly. This article reviews the most common spinal infections, their pathophysiologic, clinical manifestation, and their imaging findings.

Pyogenic Cervical Spondylodiskitis: Case Report and Current Literature Review

“…The presence of a paraspinal mass, observed as a retropharyngeal space increase (cervical SD), parietal pleura rejection (thoracic SD) and psoas effacement (lumbar SD) may be visible [10]. In the chronic phase (more than 3 months) extensive bone destruction can be observed with alterations of sagittal and / or coronal alignment (scoliosis, kyphosis), reactive sclerosis, ankylosis and spondylolisthesis [10][11][12].…”

“…Computed tomography scan (CAT) has a high sensitivity for SD, but low specificity, which is why it isn't considered a first line study for the diagnosis and it does not represent an advantage over conventional radiography in the setting of acute stage SD diagnosis [10,11]. In the sub acute stage, a greater number of radiological changes can be observed, such as an intervertebral space height decrease, osteopenia, vertebral platforms fragmentation and sub-periosteal defects.…”

“…In the sub acute phase (3 weeks-3 months), progressive radiological osteolysis, loss of bone definition, vertebral platforms irregularity and osteopenia in adjacent vertebral platforms (secondary to the inflammatory process) begin to appear [10,11]. The presence of a paraspinal mass, observed as a retropharyngeal space increase (cervical SD), parietal pleura rejection (thoracic SD) and psoas effacement (lumbar SD) may be visible [10].…”

“…An early appearance sign is an intervertebral disk space increase; however, a 30%-40% bone loss is usually required for radiological changes to be detectable, this often happens after 2 weeks onset [11].…”

“…Magnetic resonance imaging (MRI) has a sensitivity and specificity of up to 96% and 94% accordingly, with a diagnostic certainty of 94% [11].…”