Tuberculous spondylitis versus pyogenic spondylitis

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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 .

Radiographic features

Useful distinguishing features include:

  • para- or intraspinal abscess
    • presence favors tuberculous spondylitis
  • 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 vertebral intraosseous in tuberculous spondylitis
  • number of vertebral bodies involvements
    • 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
    • seen and notably severe in tuberculous spondylitis 

See also