Imaging of infections and inflammatory conditions of the spine.

The lack of specific clinical, laboratory, and radiologic findings in patients with a disease as potentially debilitating as infectious spondylitis is challenging. Biopsy will frequently need to be performed but is itself often nondiagnostic and is not without risk. Therefore, identification of findings, often subtle, that strongly favor other entities in the differential may be of just as much clinical import as identifying findings worrisome for infection, particularly in the subset of patients who otherwise are felt unlikely to have a disc space infection. Radiography and magnetic resonance (MR) imaging are complementary imaging techniques and both should be performed. The pertinent vascular anatomy of the spine; the epidemiologic, microbiologic, and clinical features of infectious spondylitis; and the role of imaging are reviewed in this article. Particular emphasis is placed on imaging differentiation of the various discovertebral disease processes.