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J Neurol Surg A Cent Eur Neurosurg 2023; 84(01): 069-076
DOI: 10.1055/s-0040-1709168
Review Article

Imaging in the Diagnosis of Nonspecific Pyogenic Spondylodiskitis

Christoph Eckhard Heyde
1   Department of Orthopedics, Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
,
Ulrich Josef Albert Spiegl
1   Department of Orthopedics, Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
,
Anna Voelker
1   Department of Orthopedics, Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
,
Nicolas von der Hoeh
1   Department of Orthopedics, Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
,
Jeanette Henkelmann
2   Department of Radiology, University of Leipzig, Leipzig, Germany
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Abstract

The prevalence of nonspecific pyogenic spondylodiskitis, associated with both a high morbidity and a high mortality, has increased in the last few decades. The diagnosis is often delayed because of the nonspecific clinical manifestation at the early stage. The reliability of radiographs is limited, particularly in early stage after the onset of infection. Computed tomography (CT) can reliably assess the bony condition with the possibility of spatial visualization. Contrast enhancement supports the detection of affected soft tissue. Magnetic resonance imaging (MRI) continues to be the gold standard in the diagnosis of spondylodiskitis. Sophisticated investigation protocols supported by gadolinium enhancement secure the diagnosis. MRI has a high resolution without radiation exposure. Different nuclear investigation techniques extend the diagnostic options. Reports of 18F-fluorodeoxyglucose-positron emission tomography (18-FDG-PET) are particularly promising to confirm the diagnosis. The drawback of the reduced image quality with respect to detailed anatomical information can be overcome by a combined simultaneous acquisition of CT or MRI. With respect to one of the greatest challenges, the differentiation between degenerative changes (Modic type 1) and infection at an early stage using differentiated MRI protocols and FDG-PET is promising. This overview presents a concise state-of-the-art look at radiologic investigations in case of suspected nonspecific pyogenic spondylodiskitis with the focus on a pragmatic approach.

Keywords

spondylodiskitis - spinal infection - radiologic investigation


Publication History

Received: 10 June 2019

Accepted: 21 October 2019

Article published online:
10 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

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