Diskitis osteomyelitis

Case contributed by Dr Bruno Di Muzio

Presentation

Back pain, bacteremia, and elevated CRP.

Patient Data

Age: 50 years
Gender: Male
CT

Note the local T8/T9 bone destruction of the osteomyelitis. 

MRI

MRI Whole Spine

Diskitis osteomyelitis centered in T8/T9 where it causes the destruction of the opposed endplates and vertebral body height loss. Apart from the fluid collection within the disc space, there is extensive phlegmon within the surrounding paravertebral soft tissues, as well as within the epidural space, where it causes focal narrowing of the spinal canal. No signs of epidural abscess. 

CT

Post-operative CT

CT scans post-surgical management with thoracic spine arthrodesis. 

Case Discussion

This case brings typical features of diskitis osteomyelitis with associated epidural phlegmon. It is important to distinguish the two main patterns of extension of the inflammatory/infective process into the epidural space:

  • phlegmonous stage of infection results in homogeneous enhancement of the abnormal area which correlate to granulomatous-thickened tissue with embedded micro-abscess without a significant pus collection
  • liquid abscess surrounded by inflammatory tissue which shows varying degree of peripheral enhancement with gadolinium
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Case information

rID: 62579
Published: 2nd Sep 2018
Last edited: 15th Mar 2019
System: Spine
Inclusion in quiz mode: Included

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