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Updated: Oct 7, 2026
Intraoperative Ultrasound in Spinal Surgery
Published on: August 17, 2022
Imaging of infections and inflammatory conditions of the spine
1Division of Radiology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Abstract:
The lack of specific clinical, laboratory, and radiologic findings in patients with a disease as potentially debilitating as infectious spondylitis is challenging. Biopsy will frequently need to be performed but is itself often nondiagnostic and is not without risk. Therefore, identification of findings, often subtle, that strongly favor other entities in the differential may be of just as much clinical import as identifying findings worrisome for infection, particularly in the subset of patients who otherwise are felt unlikely to have a disc space infection. Radiography and magnetic resonance (MR) imaging are complementary imaging techniques and both should be performed. The pertinent vascular anatomy of the spine; the epidemiologic, microbiologic, and clinical features of infectious spondylitis; and the role of imaging are reviewed in this article. Particular emphasis is placed on imaging differentiation of the various discovertebral disease processes.
Insights
Diagnosing infectious spondylitis is difficult due to nonspecific findings. This review emphasizes using radiography and magnetic resonance (MR) imaging to differentiate spinal infections from other discovertebral diseases.
Area of Science:
- Radiology
- Infectious Diseases
- Spinal Imaging
Background:
- Infectious spondylitis presents with nonspecific clinical, laboratory, and radiologic findings, complicating diagnosis.
- Biopsies, often necessary, carry risks and can be nondiagnostic.
- Differentiating infectious from non-infectious discovertebral diseases is crucial, especially in atypical cases.
Purpose of the Study:
- To review the role of imaging in diagnosing infectious spondylitis.
- To emphasize the differentiation of various discovertebral disease processes using imaging.
- To highlight the importance of subtle imaging findings in diagnosis.
Main Methods:
- Review of pertinent spinal vascular anatomy.
- Discussion of epidemiologic, microbiologic, and clinical features of infectious spondylitis.
- Emphasis on complementary roles of radiography and magnetic resonance (MR) imaging.
Main Results:
- Radiography and MR imaging are essential, complementary diagnostic tools.
- Identification of subtle findings can strongly suggest alternative diagnoses.
- Imaging plays a critical role in differentiating discovertebral diseases.
Conclusions:
- Accurate diagnosis of infectious spondylitis relies on integrating clinical data with comprehensive imaging.
- Strategic use of radiography and MR imaging aids in differentiating spinal infections.
- Recognizing subtle imaging cues is vital for accurate diagnosis and patient management.
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