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SIJ - differentials
OCI / postpartum changes
Strain-related SIJ changes
Degenerative / DISH changes
Infectious sacroiliitis
Inflammatory conditions
Metabolic disorders
Spine - differentials
Degenerative changes
Infectious spondylitis
Infectious spondylitis

Spinal infection is a rare, but a serious cause of back pain. Typically, two adjacent vertebral bodies and the intervening disk space are affected. Radiographs may be normal or non-diagnostic early in the disease, but will during the course usually reveal destruction of the vertebral plates. MRI gives the possibility of earlier diagnosis by detection of BME and enhancement in the vertebral bone as well as the disk and is helpful in detecting or excluding paravertebral and extradural abscesses.

Infectious changes especially have to be differentiated from spondylodiskitis and pseudoarthrosis in ankylosing spondylitis and disk degenerative changes with associated Modic type 1 changes.

Radiography in a patient with pronounced back pain and fever during 5 weeks showing erosion of vertebral plates without subchondral sclerosis.

MRI, sagittal and coronal T1-weighted images before (to the left) and after intravenous contrast (GD) showing destruction of the vertebral plates (arrows), but also enhancing tissue within the disk area (open arrow)c in addition to enhancement of the surrounding bones and the soft tissue posteriorly. There is no detectable abscess formation.

Infectious spondylitis with abscess formation
Infectious spondylitis with paravertebral abscess formation in a patient with back pain and fever during 4 weeks. MRI, sagittal STIR, T1 and postcontrast T1FS image in addition to a axial postcontrast T1FS image and a coronal CT reconstruction. There is pronounced edema in the Th11 and 12 vertebral bodies and in the intervening disk with an osseous defect in the inferior vertebral plate of Th11 corresponding to the destructions seen on the CT image (arrows). There is a concomitant paravertebral abscess visualized on the axial image (arrows).
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