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



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.


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.


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%).


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.


CT images Infection Pyogenic spondylitis Brucellar spondylitis Differential diagnosis 





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)


  1. 1.
    Hopkinson N, Patel K (2016) Clinical features of septic discitis in the UK: a retrospective case ascertainment study and review of management recommendations. Rheumatol Int 36:1319–1326. CrossRefPubMedGoogle Scholar
  2. 2.
    Raghavan M, Lazzeri E, Palestro CJ (2018) Imaging of spondylodiscitis. Semin Nucl Med 48:131–147. CrossRefPubMedGoogle Scholar
  3. 3.
    Kehrer M, Pedersen C, Jensen TG, Lassen AT (2014) Increasing incidence of pyogenic spondylodiscitis: a 14-year population-based study. J Infect 68:313–320. CrossRefPubMedGoogle Scholar
  4. 4.
    Foreman SC, Schwaiger BJ, Meyer B, Gersing AS, Zimmer C, Gempt J, Kirschke JS (2017) Computed tomography and magnetic resonance imaging parameters associated with poor clinical outcome in spondylodiscitis. World Neurosurg 104:919–926. CrossRefPubMedGoogle Scholar
  5. 5.
    Pola E, Taccari F, Autore G, Giovannenze F, Pambianco V, Cauda R, Maccauro G, Fantoni M (2018) Multidisciplinary management of pyogenic spondylodiscitis: epidemiological and clinical features, prognostic factors and long-term outcomes in 207 patients. Eur Spine J 27:229–236. CrossRefPubMedGoogle Scholar
  6. 6.
    Franc KA, Krecek RC, Hasler BN, Arenas-Gamboa AM (2018) Brucellosis remains a neglected disease in the developing world: a call for interdisciplinary action. BMC Public Health 18:125. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Oztekin O, Calli C, Adibelli Z, Kitis O, Eren C, Altinok T (2010) Brucellar spondylodiscitis: magnetic resonance imaging features with conventional sequences and diffusion-weighted imaging. Radiol Med 115:794–803. CrossRefPubMedGoogle Scholar
  8. 8.
    Gao M, Sun J, Jiang Z, Cui X, Liu X, Wang G, Li T, Liang C (2017) Comparison of tuberculous and brucellar spondylitis on magnetic resonance images. Spine 42:113–121. CrossRefPubMedGoogle Scholar
  9. 9.
    Frel M, Białecki J, Wieczorek J, Paluch Ł, Dąbrowska-Thing A, Walecki J (2017) Magnetic resonance imaging in differentatial diagnosis of pyogenic spondylodiscitis and tuberculous spondylodiscitis. Pol J Radiol 82:71 87. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Li T, Li W, Du Y, Gao M, Liu X, Wang G, Cui H, Jiang Z, Cui X, Sun J (2018) Discrimination of pyogenic spondylitis from brucellar spondylitis on MRI. Medicine (Baltimore) 97:e11195. CrossRefGoogle Scholar
  11. 11.
    Koubaa M, Maaloul I, Marrakchi C, Lahiani D, Hammami B, Mnif Z, Ben MK, Hammami A, Ben JM (2014) Spinal brucellosis in South of Tunisia: review of 32 cases. Spine J 14:1538–1544. CrossRefPubMedGoogle Scholar
  12. 12.
    Sheikh AF, Khosravi AD, Goodarzi H, Nashibi R, Teimouri A, Motamedfar A, Ranjbar R, Afzalzadeh S, Cyrus M, Hashemzadeh M (2017) Pathogen identification in suspected cases of pyogenic spondylodiscitis. Front Cell Infect Microbiol 7:60. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Panta OB, Pathak YR, Karki DB (2018) Magnetic resonance imaging findings in spondylodiscitis. J Nepal Health Res Counc 15:217–221CrossRefGoogle Scholar
  14. 14.
    Kumar Y, Gupta N, Chhabra A, Fukuda T, Soni N, Hayashi D (2017) Magnetic resonance imaging of bacterial and tuberculous spondylodiscitis with associated complications and non-infectious spinal pathology mimicking infections: a pictorial review. BMC Musculoskelet Disord 18:244. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Ramadani N, Dedushi K, Kabashi S, Mucaj S (2017) Radiologic diagnosis of spondylodiscitis, role of magnetic resonance. Acta Inform Med 25:54–57. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Ledermann HP, Schweitzer ME, Morrison WB, Carrino JA (2003) MR imaging findings in spinal infections: rules or myths? Radiology 228:506–514. CrossRefPubMedGoogle Scholar
  17. 17.
    Rausch VH, Bannas P, Schoen G, Froelich A, Well L, Regier M, Adam G, Henes FO (2017) Diagnostic yield of multidetector computed tomography in patients with acute spondylodiscitis. Rofo 189:339–346. CrossRefPubMedGoogle Scholar
  18. 18.
    Mete B, Kurt C, Yilmaz MH, Ertan G, Ozaras R, Mert A, Tabak F, Ozturk R (2012) Vertebral osteomyelitis: eight years' experience of 100 cases. Rheumatol Int 32:3591–3597. CrossRefPubMedGoogle Scholar
  19. 19.
    Ozaksoy D, Yucesoy K, Yucesoy M, Kovanlikaya I, Yuce A, Naderi S (2001) Brucellar spondylitis: MRI findings. Eur Spine J 10:529–533CrossRefGoogle Scholar
  20. 20.
    Sharif HS, Clark DC, Aabed MY, Haddad MC, Al DS, Yaqub B, Al MK (1990) Granulomatous spinal infections: MR imaging. Radiology 177:101–107. CrossRefPubMedGoogle Scholar
  21. 21.
    Tekkok IH, Berker M, Ozcan OE, Ozgen T, Akalin E (1993) Brucellosis of the spine. Neurosurgery 33:838–844PubMedGoogle Scholar

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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