Revision 2 for 'Tuberculous spondylitis versus pyogenic spondylitis'

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Tuberculous spondylitis versus pyogenic spondylitis

Distinguishing between tuberculous spondylitis and pyogenic spondylitis are both common causes of spinal infection. Imaging findings of these 2 diseases can be hard to distinguish, yet crucial because the treatments for these infections are particularly different.

Radiographic features

Useful distinguishing features include:

  • para- or intraspinal abscess
    • presence favors tuberculous spondylitis
  • abscess wall
    • pyogenic spondylitis walls are thick and irregular
    • tuberculous spondylitis walls are thin and smooth
  • post-contrast paraspinal abnormal signal margin
    • pyogenic spondylitis margins are ill-defined
    • tuberculous spondylitis margins are well defined
  • abscess with post-contrast rim enhancement
    • involves the disc in pyogenic spondylitis
    • involves vertebral intraosseous in tuberculous spondylitis
  • number of vertebral bodies involvements
    • pyogenic spondylitis tends to only involve no more than 2 vertebral bodies.
    • tuberculous spondylitis involve multiple vertebral bodies
  • location
    • lumbar spine are common locations for pyogenic spondylitis
    • thoracic spine are common locations for tuberculous spondylitis
  • intervertebral disc
    • moderate to complete destruction in pyogenic spondylitis
    • mild destruction or spared in tuberculous spondylitis
  • vertebral bone
    • seen and notably severe in tuberculous spondylitis

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