Spondylodiskitis MedPix

Description: Pyogenic spondylodiskitis has a variable clinical presentation. The incidence peaksin the 6th and 7th decades. S. Aureus and enterobacter account for approximately 60% and 30% of cases, respectively. The infection may result from hematogenous seeding, direct extension, surgery or trauma. Intravenous drug abuse and immune dysfunction are risk factors. In adults, the infection typically begins in the subchondral bone of the vertebral body and spreads to the adjacent disk. In children, the disk itself is more likely to be involved first. Cord compromise may result from an epidural abscess. MR findings in pyogenic spondylitis include narrowing of the disk space with low T1, high T2 and enhancement in the adjacent vertebral endplates. Bony destruction and paraspinal abscesses are common. Granulomatous spondylitis also has a variable clinical course, but tends to be more indolent. Peak incidence is in the 5th decade. M. tuberculosis, brucella species, and fungal agents predominate, although neoplastic , autoimmune and idiopathic diseases may cause a similar process. Multilevel involvement ("skip lesions") and multiple paraspinal soft tissue abscesses are common.