Pitfalls in Imaging of Spinal Infection

The most common spine infection, spondylodiskitis centered on a single disk level with adjacent bone inflammation and destruction, is easily diagnosed. But as discussed in this article, a number of presentations are difficult to diagnose at first presentation. After a short introduction and review of imaging modalities, specific imaging manifestations of spine infection and their differential diagnoses are described.This review looks at inflammatory end-plate changes, epidural collection, posterior element changes, paravertebral inflammation, and isolated disk signal change. The differential diagnoses are listed. A sizable number of cases, many of which were initially misdiagnosed, are described to illustrate pertinent points.The most important lesson is to perform short-term follow-up cross-sectional imaging if a diagnosis of infection is considered but cannot be clearly established.