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Spinal Discitis and Osteomyelitis: Sensitivity and Specificity

Introduction: Infection of the vertebral bodies, centered at the intervertebral disc. The infection often spreads to the prevertebral soft tissues and into the epidural space. It most commonly affects the lumbar spine.

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Tags: Infection Neurologic Tag this Diagnosis.

The sensitivity and specificity of findings for Spinal Discitis and Osteomyelitis are listed below. See the left navigation bar to change the display.

Sensitive and Specific Findings

Finding SensitivitySpecificity Comments, Study
Gallium WBC Scan and Bone Scan Edit 90%100%

Study: Radiology. 1985 Oct;157(1):157-66. PMID: 3875878

MRI Edit 96%92%

most sensitive findings: increased disc T2 and disc enhancement, endplate erosion, soft tissue mass.

Best early clue to differentiate from degenerative (Modic) changes: increased T2 signal in the disc; obviously soft tissue mass would do so as well.

Study: Radiology. 1985 Oct;157(1):157-66. PMID: 3875878

Eur J Radiol. 2006 Apr;58(1):27-40. PMID: 16413726

Tc99m Bone Scan Edit 87%91%

three-phase bone scan (hot during blood pool and bone phase)

Study: Eur J Radiol. 2006 Apr;58(1):27-40. PMID: 16413726

Sensitive Findings

Finding SensitivitySpecificity Comments, Study
Elevated CRP Edit Sensitivity = 100%

Study: Eur J Radiol. 2006 Apr;58(1):27-40. PMID: 16413726

Localized Pain Edit Sensitivity = 95%

Study: Eur J Radiol. 2006 Apr;58(1):27-40. PMID: 16413726

Poorly Diagnostic Findings

Finding SensitivitySpecificity Comments, Study
Spine X-Ray Edit 82%57%

findings include loss of disc height and endplate destruction

Study: Eur J Radiol. 2006 Apr;58(1):27-40. PMID: 16413726

Elevated ESR Edit Sensitivity = 80%

reportedly elevated in 100% of patients with epidural abscess

Study: Eur J Radiol. 2006 Apr;58(1):27-40. PMID: 16413726

Blood Cultures Edit Sensitivity = 56%

Study: Eur J Radiol. 2006 Apr;58(1):27-40. PMID: 16413726

Focal Neurological Signs Edit Sensitivity = 40%

Study: Eur J Radiol. 2006 Apr;58(1):27-40. PMID: 16413726

Leukocytosis Edit Sensitivity = 40%

Study: Eur J Radiol. 2006 Apr;58(1):27-40. PMID: 16413726