SD is an infectious disease of spine which involves the intervertebral disk (IVD),
vertebral bodies (VB),
joints,
paraspinal tissues.
Most common manifestations and complications of SD are VB destruction and fractures,
infiltration of IVD,
epidural and paraspinal (localized in muscles,
retroperitoneal space) puss collections,
spinal canal stenosis,
myelitis.
Except VB fractures and destruction,
almost all of these symptoms impossible to diagnose with routine X-ray because of its low sensitivity,
especially changes in spinal canal and spinal cord.
Valid diagnostics of SD by X-ray is possible only with the damage at least 30% of the volume of the VB bone structure [1].
SD complications cause seriously neurological deficiency and may be the reason of mobility limitation.
That’s why early diagnostics by MRI and CT of SD is very important and it’s one of the “key” of good patient prognosis.
The sensitivity of MRI in the diagnostic of SD is 96-100%,
specificity is 92% [2].
The earliest manifestations of SD is possible to visualize only by MRI.
It’s include infiltration and edema of VB and IVD (high MR-signal on T2 and FatSat/STIR sequences and low on T1) – sensitivity of these symptoms more than 80% [3].
On T1 borders between IVD and VB becomes difficult to see (Fig.1).
Myelitis and epidural abscesses exactly detected only by MRI.
Contrast enhancement (CE) injection is important in determination of inflammation activity [3] (Fig.2).
Complete absence of CE in VB after injury (Fig.3) is a true sign of irreversible changes in bone tissue (necrosis).
Destruction volume and vertebral fractures is better detected by CT (Fig.
4).
Paraspinal soft tissues infiltrations,
m.
psoas major and retroperitoneal puss collections,
epidural abscesses can be visualized both by CT and MRI,
however sensitivity of MRI (especially with CE) is higher.
CT remains the only reliable radiology method by patients with absolute contraindications for MRI,
for example,
after surgery (transpedicular screw fixation,
etc),
in the case of suspected gunshot SD to avoid migration of the bullet [4].
From 01.2016 to 09.2017 in our clinic were hospitalized 42 patients with a SD (25,58% of all cases for 14M people in Moscow),
36 (85,7%) from them were examined by MRI,
and 24 (56,5%) by CT.