Spondylodiskitis is osteomyelitis of the vertebral bodies and intervertebral disk secondary to an infectious process. Hematogenous spread of pathogens is the most common route of seeding. It leads to erosions, destruction, and compression fractures with resulting spinal instability, deformity, and risk of cord compression. The infection can breach the bone and spread into surrounding soft tissues, causing paravertebral or psoas abscesses, and track into the central canal, forming an epidural abscess.

The predominant pyogenic pathogen is S. Aureus with a distant focus of infection being identified in almost 50% of cases. Hematogenous bacterial spondylodiscitis affects preferentially the lumbar spine, followed by the thoracic then cervical spine.

Although CT is good at delineating bone abnormalities including early endplate erosions, MR is considered the modality of choice for assessment of spondylodiscitis and its associated complications.

Case co-author: Rehana Jaffer, MD, FRCPC