Spondylodiskitis

Case contributed by Anthony Nuñez
Diagnosis almost certain

Presentation

Back pain and fever.

Patient Data

Age: 60 years
Gender: Male
x-ray

Frontal projection: increased density at the surrounding tissue of the vertebral endplates of T8-T9. 

Lateral projection: ill-definition of the vertebral endplates of  T8-T9. 

ct

There is a destruction of T8-T9 end plates with reduced height of the vertebral body of T8. 

mri

There is a marked inflammatory process involving the endplates of the thoracic vertebral bodies of T8 and T9, associated with fluid signal intensity in the local intervertebral disc.

On post-contrast images, there is an intense enhancement of vertebral endplates and paravertebral soft tissues. The inflammatory process obliterates the local foraminal spaces and reduces the spinal canal by extension into the epidural space.

Case Discussion

Spondylodiscitis usually occur at lumbar spine but it could be at any location in the vertebral column, as in this case where it was at the thoracic column on a single level.  

When it compromises the lumbar spine, it is common to see the extension of the inflammatory process to the psoas muscle. 

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