Imagerie diagnostique de la spondylodiscite infectieuse

Abstract

Infection of the spine including any part of the vertebra is called infectious spondylitis. Infectious spondylitis is primarily due to hematogenous spread of organism. The most common pyogenic germ is Staphylococcus aureus. Tuberculous spondylis has become the most frequent manifestation of osteoarticular tuberculosis. Clinical manifestation is often acute or subacute back pain with fever and rigidity over the involved segment. Because of non specificity of the symptoms, the initial plain films are usually normal. However, the earliest radiographics sign remain a blurring of the endplates and a decrease in the disk space height. Magnetic resonance imaging is the imaging modality of choice in assessing spondylodiskitis, especially in the early phase when the bone marrow oedema is detected before the destructive process. Post contrast T1 weighted SE sequences with fat-saturation are useful in epidural involvement or paravertebral abscess. Differential diagnosis include : degenerative disk disease spondylarthropathy and neoplastic disease. A specific microbiologic diagnosis is highly desirable for definitive medical treatment with antibiotics : blood cultures, fluoroscopy or CT-guided percutaneous spine biopsy.