Computed tomography imaging characteristics help to differentiate pyogenic spondylitis from brucellar spondylitis

Area of Science:

• Radiology
• Infectious Diseases
• Orthopedics

Background:

• Pyogenic spondylitis (PS) and brucellar spondylitis (BS) present diagnostic challenges due to similar potential for causing deformities and neurologic deficits.
• Prompt diagnosis and treatment are crucial for preventing long-term complications in both conditions.

Purpose of the Study:

• To compare the computed tomography (CT) imaging features of pyogenic spondylitis (PS) and brucellar spondylitis (BS).
• To identify distinct CT findings that aid in the differential diagnosis between PS and BS.

Main Methods:

• A retrospective analysis of CT images from 32 patients with PS and 44 patients with BS.
• Systematic collection and comparison of data on bone destruction, bone formation, vertebral wall destruction, and osteosclerotic changes.
• Statistical analysis using Chi-square or t tests, with a significance level of P < 0.01.
• Calculation of positive predictive values (PPV) for key differentiating features.

Main Results:

• Brucellar spondylitis (BS) more commonly involved lumbar vertebrae and multiple spinal levels compared to pyogenic spondylitis (PS).
• PS demonstrated significantly greater bone destruction (30.8% vs 18.0%) and vertebral body destruction (35.8% vs 12.5%) than BS.
• BS showed increased osteosclerosis around erosions (70.5% vs 43.3%), fan-shaped osteosclerosis (27.3% vs 19.4%), and extensive anterior bone formation (77.2% vs 34.3%), including longer anterior bone formation (3.55 mm vs 0.78 mm).

Conclusions:

• CT imaging offers unique advantages in differentiating PS from BS by revealing characteristic patterns of erosion, osteosclerosis, and bone formation.
• Specific CT findings, such as the extent of bone destruction and the morphology of osteosclerosis and bone formation, are key to distinguishing between these two types of spondylitis.