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Computed tomography imaging characteristics help to differentiate pyogenic spondylitis from brucellar spondylitis

  • Xiaoyang Liu
  • Meimei Zheng
  • Zhensong Jiang
  • Guodong Wang
  • Tao Li
  • Jianmin SunEmail author
  • Xingang CuiEmail author
Original Article

Abstract

Purpose

Both pyogenic spondylitis (PS) and brucellar spondylitis (BS) can cause deformities and permanent neurologic deficits without prompt diagnosis and treatment. However, differential diagnosis is challenging. The aim of this study was to compare the computed tomography (CT) imaging features of PS with those of BS.

Methods

Thirty-two patients with PS and 44 with BS were enrolled in the study. CT images were obtained in all cases. Data on bone destruction and formation, vertebral wall destruction, and osteosclerotic changes were collected and compared using the Chi-square test or t test. A P value < 0.01 was considered statistically significant. Positive predictive values (PPV) for detecting PS or BS were reported.

Results

Involvement of the lumbar vertebrae and multiple spinal levels was more common in the BS group than in the PS group. Bone destruction was significantly greater in the PS group than in the BS group (30.8 vs 18.0%; t = 3.920, P = 0.000), with more extensive destruction of the vertebral body (35.8 vs 12.5%, χ2 = 12.672, P = 0.002, PPV = 63.16%). In the BS group, there was more osteosclerosis around erosions (70.5 vs 43.3%, χ2 = 11.59, P = 0.001, PPV = 67.74%) and fan-shaped osteosclerosis (27.3 vs 19.4%, χ2 = 18.556, P = 0.006, PPV = 64.86%), more bone formation around the vertebra (77.2 vs 34.3%, χ2 = 33.608, P = 0.000, PPV = 76.83%), more bone formation under the anterior longitudinal ligament (63.6 vs 19.4%, χ2 = 30.133, P = 0.000, PPV = 76.09%), more longer anterior bone formation (3.55 vs 0.78 mm, t = 3.997, P = 0.000), and more anterior and closed-bone formation with local erosion (42.0 vs 9.0%, χ2 = 74.243, P = 0.000, PPV = 74.36%).

Conclusions

CT images have unique advantages of revealing the morphology of erosions, osteosclerosis, and bone formation around the vertebra and help to differentiate PS from BS.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

CT images Infection Pyogenic spondylitis Brucellar spondylitis Differential diagnosis 

Notes

Acknowledgments

None.

Funding

None declared.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_6214_MOESM1_ESM.pptx (13.6 mb)
Supplementary file1 (PPTX 13974 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Spine SurgeryShandong Provincial Hospital Affiliated To Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan CityChina
  2. 2.Department of NeurologyThe First affiliated Hospital of Shandong First Medical University; Shandong Provincial Qianfoshan Hospital, Shandong UniversityJinan CityChina

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