Late correlative imaging findings of previous acute infective spondylitis

To evaluate late correlative imaging findings in relation to clinical outcome in persons with previous acute infective spondylitis, the authors performed bone and leukocyte scintigraphy (planar and SPECT imaging) and magnetic resonance imaging of the spine in nine patients (two men, seven women; mean age, 66 years; age range, 57 to 84 years) 3.1 years (range, 0.9 to 6.2 years) after the acute disease.

All images were evaluated visually. The relevant uptake on SPECT images was also quantitated using an adjacent normal vertebral body as the reference area.

Except for one patient, all other patients had increased uptake in the affected vertebra on bone scintigraphy [corrected]. In leukocyte scintigraphy, clearly decreased uptake was noted quantitatively in six of the seven patients who underwent SPECT. On the magnetic resonance and computed tomographic scans, the typical findings were destruction of intervertebral disks and compression deformities of vertebral bodies, but there was high interindividual variance of other findings, such as osteophytes, spondylolisthesis, increased vertebral fat content, and postoperative changes. These data show that nearly all patients with previously acute infective spondylitis have gross abnormal anatomic and functional imaging findings years after the acute disease, despite good clinical outcome [corrected].

The utility of bone and leukocyte scans in the diagnosis of reactivated spondylitis is limited, and incidentally observed abnormal imaging findings in asymptomatic patients with known previous spondylitis should be interpreted with caution.