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Discitis involving the thoracic spine

Case contributed by Andrew Lawson
Diagnosis almost certain

Presentation

Back pain and fevers.

Patient Data

Age: 60
Gender: Male

Abnormality of T5, T6 vertebral bodies and the intervening T5/6 intervertebral disc with low T1, bright T2 and STIR signal and avid contrast enhancement of these vertebrae.

Linear low signal at the vertebral body end plates suggests sclerosis. Circumferential epidural enhancement extends from T4/5 to T5/6. Small prevertebral, vividly enhancing tissue anteriorly adjacent to T5/6, approximately 7mm depth. Complete destruction of the inferior endplate of T5, superior endplate of T6 and T5/6 disc. Abnormal enhancement is also noted surrounding the T5 nerve roots at the T5/ 6 intervertebral foramina bilaterally, becoming continuous with the aforementioned pre-vertebral enhancing tissue.

Bright T2/STIR signal and focal contrast enhancement within the T12 /L1 intervertebral disc. No subdural enhancement or spinal cord impingement is identified. Thoracic cord signal is normal.

Incidental note made of Klippel-Feil spectrum congenital abnormality of the neck with small, partially fused C4/5 vertebral bodies and intervening disc as well as partial fusion of the associated posterior elements.

Conclusions:

  1. Destructive change at the T5/6 disc with endplate sclerosis and adjacent vertebral body edema. Abnormal enhancement extends into the epidural space and paravertebral soft tissues. Osteomyelitis/discitis, including more chronic etiologies such as tuberculosis, should be excluded. Less likely causes may include amyloid, other depositional arthropathies or neuropathic changes. Normal cord signal.
  2. Bright T2/STIR signal and focal contrast enhancement within the T12/L1 intervertebral disc may be degenerative, however in this clinical setting, a separate site of discitis is not excluded.

Case Discussion

Spondylodiscitis is characterized by infection involving the intervertebral disc and adjacent vertebrae.

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