Tuberculous spondylitis and pyogenic spondylitis are both common causes of spinal infection. Imaging findings of these two diseases can be challenging to distinguish, yet crucial because the treatments for these infections are particularly different 2.
Radiographic features
Useful distinguishing features include:
- para- or intraspinal abscess
- presence favours tuberculous spondylitis 5
- abscess wall
- pyogenic spondylitis walls are thick and irregular
- tuberculous spondylitis walls are thin and smooth
- postcontrast paraspinal abnormal signal margin
- pyogenic spondylitis margins are ill-defined
- tuberculous spondylitis margins are well-defined
- abscess with postcontrast rim enhancement
- involves the disc in pyogenic spondylitis
- involves vertebra (intraosseous) in tuberculous spondylitis
- number of vertebral bodies involved
- pyogenic spondylitis tends to only involve no more than 2 vertebral bodies
- tuberculous spondylitis involves 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 destruction
- more frequent and more severe in tuberculous spondylitis
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