Semin Musculoskelet Radiol 2004; 8(3): 215-229
DOI: 10.1055/s-2004-835362
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

MR Imaging of Spinal Infection

Bernhard J. Tins1 , Victor N. Cassar-Pullicino1
  • 1Department of Radiology, The Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, United Kingdom
Further Information

Publication History

Publication Date:
11 October 2004 (online)

Magnetic resonance (MR) imaging plays a pivotal role in the diagnosis and management of spinal infection, enjoying a high sensitivity and specificity. A thorough understanding of spinal anatomy and the physicochemical pathological processes associated with infection is a desirable prerequisite allowing accurate interpretation of the disease process. Apart from confirmation of the disease, MR imaging is also best suited to excluding multifocal spinal involvement and the detection/exclusion of complications. It plays an essential role in the decision-making process concerning conservative versus surgical treatment and is also the best imaging method to monitor the effect of treatment. The MR features of infection confidently exclude tumor, degeneration, and so forth as the underlying process; differentiate pyogenic from granulomatous infections in most cases; and can suggest the rarer specific infective organisms.

REFERENCES

  • 1 Khan I A, Vaccaro A R, Zlotolow D A. Management of vertebral discitis and osteomyelitis.  Orthopedics. 1999;  22 758-765
  • 2 Dagirmanjian A, Schils J, McHenry M C. MR imaging of spinal infections.  Magn Reson Imaging Clin N Am. 1999;  7 525-538
  • 3 Mahboubi S, Morris M C. Imaging of spinal infections in children.  Radiol Clin North Am. 2001;  39 215-222
  • 4 Varma R, Lander P, Assaf A. Imaging of pyogenic infectious spondylodiscitis.  Radiol Clin North Am. 2001;  39 203-213
  • 5 Moore S L, Rafii M. Imaging of musculoskeletal and spinal tuberculosis.  Radiol Clin North Am. 2001;  39 329-342
  • 6 Rothman S L. The diagnosis of infections of the spine by modern imaging techniques.  Orthop Clin North Am. 1996;  27 15-31
  • 7 Glazer P A, Hu S S. Pediatric spinal infections.  Orthop Clin North Am. 1996;  27 111-123
  • 8 Ring D, Wenger D A. Pyogenic infectious spondylitis in children. The evolution to current thought.  Am J Orthop. 1996;  25 342-348
  • 9 Sapico F L. Microbiology and antimicrobial therapy of spinal infections.  Orthop Clin North Am. 1996;  27 9-13
  • 10 Ozuna R M, Delamarter R B. Pyogenic vertebral osteomyelitis and postsurgical disc space infections.  Orthop Clin North Am. 1996;  27 87-94
  • 11 Wiley A, Trueta J. The vascular anatomy of the spine and its relationship to pyogenic vertebral osteomyelitis.  J Bone Joint Surg Br. 1959;  41 796-809
  • 12 Calderone R R, Larsen J M. Overview and classification of spinal infections.  Orthop Clin North Am. 1996;  27 1-8
  • 13 Batson O. The vertebral vein system. Caldwell lecture 1956.  Am J Roentgenol Radium Ther Nucl Med. 1957;  78 195-212
  • 14 Coman D, DeLong R. The role of the vertebral venous system in the metastasis of cancer to the spinal column; experiments with tumor-cell suspensions in rats and rabbits.  Cancer. 1951;  4 610-618
  • 15 Vaccaro A, Shah S H, Schweitzer M E, Rosenfeld J F, Cotler J M. MRI description of vertebral osteomyelitis, neoplasm, and compression fracture.  Orthopedics. 1999;  22 67-73
  • 16 Boden S D, Davis D O, Dina T S. Postoperative discitis: distinguishing early MR imaging findings from normal postoperative disc space changes.  Radiology. 1992;  184 765-771
  • 17 Viola R W, King H A, Adler S M, Wilson C B. Delayed infection after elective spinal instrumentation and fusion. A retrospective analysis of eight cases.  Spine. 1997;  22 2444-2451
  • 18 Schofferman L, Zucherman J, Schofferman J et al.. Diptheroids and associated infections as a cause of failed instrument stabilization procedures in the lumbar spine.  Spine. 1991;  16 356-358
  • 19 Modic M T, Feiglin D H, Piraino D W et al.. Vertebral osteomyelitis: assessment using MR.  Radiology. 1985;  157 157-166
  • 20 Moorthy S, Prabhu N K. Spectrum of MR imaging findings in spinal tuberculosis.  AJR Am J Roentgenol. 2002;  179 979-983
  • 21 Boachie-Adjei O, Squillante R G. Tuberculosis of the spine.  Orthop Clin North Am. 1996;  27 95-103
  • 22 Shanley D J. Tuberculosis of the spine: imaging features.  AJR Am J Roentgenol. 1995;  164 659-664
  • 23 Rodiek S O. Diagnostic methods in spinal infections.  Radiologe. 2001;  41 976-986
  • 24 Küker W, Mull M, Mayfrank L, Topper R, Thron A. Epidural spinal infection; variability of clinical and magnetic resonance imaging findings.  Spine. 1997;  22 544-551
  • 25 Sharif H S, Aideyan O A, Clark D C et al.. Brucellar and tubercular spondylitis: comparative imaging features.  Radiology. 1989;  171 419-425
  • 26 Post M J, Quencer R M, Mohtalvo B M, Katz B H, Eismont F J, Green B A. Spinal infection: evaluation with MR imaging and intraoperative US.  Radiology. 1988;  169 765-771
  • 27 Jinkins J R, Bazan 3rd C, Xiong L. MR of disc protrusion engendered by infectious spondylitis.  J Comput Assist Tomogr. 1996;  20 715-718
  • 28 Gillams A R, Chaddha B, Carter A P. MR appearances of the temporal evolution and resolution of infectious spondylitis.  AJR Am J Roentgenol. 1996;  166 903-907
  • 29 Dagirmanjian A, Schils J, Mc Henry M, Modic M T. MR imaging of vertebral osteomyelitis revisited.  AJR Am J Roentgenol. 1996;  167 1539-1543
  • 30 Wolansky L, Heary R F, Patterson T et al.. Pseudosparing of the endplate: a potential pitfall in using MR imaging to diagnose infectious spondylitis.  AJR Am J Roentgenol. 1999;  172 777-780
  • 31 Green R, Saifuddin A, Gibson A. Vertebral osteomyelitis without disc involvement: MR imaging features in 14 patients. International Skeletal Society Meeting Geneva; September 2002
  • 32 Kenney 3rd C M, Goldstein S J. MRI of sarcoid spondylodiscitis.  J Comput Assist Tomogr. 1992;  16 660-662
  • 33 Sharma A, Goyal M, Mishra N K, Gupta V, Gaikwad S D. MR imaging of tubercular spinal arachnoiditis.  AJR Am J Roentgenol. 1997;  168 807-812
  • 34 Loke T, Ma H, Chan C. Magnetic resonance imaging of tuberculous spinal infection.  Australas Radiol. 1997;  41 7-12
  • 35 Abdelwahab I F, Camins M B, Hermann G, Klein M J. Vertebral arch or posterior spinal tuberculosis.  Skeletal Radiol. 1997;  26 737-740
  • 36 Bielecki D, Sartoris D, Resnick D, Van Lom K, Fierer J, Haghighi P. Intraosseous and intradiscal gas in association with spinal infection.  AJR Am J Roentgenol. 1986;  147 83-86
  • 37 Urban & Schwarzenberg Roche Lexikon Medizin, 3rd ed. Munich; Urban & Schwarzenberg 1993
  • 38 Saccente M, Abernathy R S, Pappas P G, Shah H R, Bradsher R W. Vertebral blastomycosis with paravertebral abscess: report of 8 cases and review of the literature.  Clin Infect Dis. 1998;  26 413-418
  • 39 Olson E M, Duberg A C, Herron L D, Kissel P, Smilovitz D. Coccidioidal spondylitis: MR findings in 15 patients.  AJR Am J Roentgenol. 1998;  171 785-789
  • 40 Malghem J, Maldague B, Labaisse M A et al.. Intravertebral vacuum cleft: changes in content after supine positioning.  Radiology. 1993;  187 483-487
  • 41 Nachtigal A, Cardinal E, Bureau N J, Sainte-Marie L G, Milette F. Vertebral involvement in SAPHO syndrome: MRI findings.  Skeletal Radiol. 1999;  28 163-168
  • 42 Toussirot E, Dupond J L, Wendling D. Spondylodiscitis in SAPHO syndrome. A series of eight cases.  Ann Rheum Dis. 1997;  56 52-58
  • 43 Stäbler A, Baur A, Krüger A, Weiss M, Helmberger T, Reiser M. Differential diagnosis of erosive osteochondrosis and bacterial spondylitis: magnetic resonance tomography (MRT) [in German].  Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 1998;  168 421-428
  • 44 Leone A, Sundaram M, Cerase A, Magnavitia N, Tazza L, Marano P. Destructive spondyloarthropathy of the cervical spine in long-term hemodialyzed patients: a five-year clinical radiological prospective study.  Skeletal Radiol. 2001;  30 431-441

Victor N Cassar-PullicinoL.R.C.P. M.R.C.S. M.D. D.M.R.D. F.R.C.R. 

Department of Radiology, The Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry

Shropshire SY10 7AG, United Kingdom

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