Spinal and spinal cord infection

Abstract

This review article includes infections of the vertebral body, intervertebral disc, ligaments and paravertebral soft tissues, epidural space, meninges and subarachnoid space, and the spinal cord. A wide range of infective organisms may be implicated and the incidence of some, notably tuberculosis, is rising due to increased immunocompromise and other factors. Imaging plays a key role in early diagnosis of these diseases, which may be severe and potentially life threatening. Infection may be acquired by the hematogenous route, by infection from contiguous structures or from direct inoculation. Of available imaging techniques, CT and MRI offer the clinically most valuable methods of evaluating all the structures potentially involved in infection. Although many signs are non-specific, indication is given of where appearances raise strong suspicion of infection. The extent of the inflammatory process is well evaluated by imaging, particularly in terms of severity and morbidity of clinical sequelae, which may be severe. Early investigation is mandatory and as MRI presently has the key role in investigation, it should be employed at an early stage of clinical suspicion.

Severe vertebral collapse in a juvenile from the graveyard (13th/14th–19th centuries) of the São Miguel church (Castelo Branco, Portugal): differential palaeopathological diagnosis

“…It can be questioned whether they are related to a tuberculous collateral phenomenon such as paravertebral abscess-a frequent finding on imaging techniques in patients suffering from tuberculous spondylitis (Panuel et al, 1999;Teo & Peh, 2004;Imhof, 2005;Harada et al, 2008). Once a paravertebral abscess is formed the disease can spread via the anterior or posterior longitudinal ligaments and extend to the pleural space (Balériaux & Neugroschl, 2004). In fact, tuberculous infection may be more extensive than is shown by conventional radiology and cause involvement of the posterior thoracic elements (Cremin, 1999), namely adjacent ribs (Resnick, 1996c;Cremin, 1999;Roberts & Manchester, 2005) and costovertebral joints (Sebes, 1999, as observed in our case.…”

“…From the clinical point of view, the imaging features of tuberculous spondylitis may resemble those seen in pyogenic spinal infections, thus their clinical differentiation can be intricate (Balériaux & Neugroschl, 2004;Jevtic, 2004;Teo & Peh, 2004;Imhof, 2005;Harada et al, 2008). Concerning the skeleton number 8, the putative demarcation of these entities should consider the articulation of palaeopathological and clinical evidence as follows:…”

Imaging the posterior mediastinum: a multimodality approach

“…Infection of a vertebral body may extend into the pre-and paravertebral soft tissues, spreading via the anterior or posterior longitudinal ligaments ( Fig. 3) (12,13).…”

“…ized on CT (13,15). In addition, MRI allows assessment of epidural masses with nerve root or spinal cord compression (Fig.…”

Imaging of the Lumbar Spine Neoplasms

“…In case of contiguous extension of the infection, an epidural abscess may be evident. [66][67][68] Attention should be paid to the atypical infections. Spinal tuberculosis usually represents a secondary focus.…”