Musculoskeletal Imaging

Discitis

infection of the intervertebral disc, usually occurring by spread from adjacent vertebral osteomyelitis, although in children a haematogenous extension may occur. Direct inoculation of infectious organisms into the disc may follow discography or disc surgery.

Frequently the intervertebral disc space is narrowed, and in ankylosing spondylitis erosive abnormalities of the discovertebral junction due to various mechanisms may be observed (Fig.1). Sclerosis is common, and rarely a psoas abscess develops. Other features include osteophytosis, spondylolisthesis, vertebral wedging, kyphosis and scoliosis.

Bone scans may show increased uptake of bone-seeking radiopharmaceutical agents, and both CT scanning and MR imaging are useful in diagnosis. On CT scans a soft tissue mass and multiple erosions are seen in the bony endplates on either side of the involved intervertebral disc space. MR images reveal increased signal intensity of the disc and adjacent vertebral body on T2-weighted images.

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Fig.1

AP (a) and lateral (b) radiographs of the lumbar spine demonstrate disc space narrowing and endplate irregularity due to discitis.
Discitis, Fig.1 (a)
Discitis, Fig.1 (b)