Spinal Discitis and Osteomyelitis: Likelihood Ratios

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.

[Edit Diagnosis] [Merge dx] [Add prevalence]

Tags: Infection Neurologic Tag this Diagnosis.

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

Good Positive and Negative Likelihood Ratios

Finding	+LR	-LR	Comments, Study
MRI	12	0	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
Gallium WBC Scan and Bone Scan	inf	0.1	Study: Radiology. 1985 Oct;157(1):157-66. PMID: 3875878
Tc99m Bone Scan	9.7	0.1	three-phase bone scan (hot during blood pool and bone phase) Study: Eur J Radiol. 2006 Apr;58(1):27-40. PMID: 16413726

Good Negative Likelihood Ratio

Spine X-Ray

1.9

0.3

findings include loss of disc height and endplate destruction

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

Poorly Diagnostic Findings

Finding	+LR	-LR	Comments, Study
Elevated CRP	Sensitivity = 100%		Study: Eur J Radiol. 2006 Apr;58(1):27-40. PMID: 16413726
Localized Pain	Sensitivity = 95%		Study: Eur J Radiol. 2006 Apr;58(1):27-40. PMID: 16413726
Elevated ESR	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	Sensitivity = 56%		Study: Eur J Radiol. 2006 Apr;58(1):27-40. PMID: 16413726
Focal Neurological Signs	Sensitivity = 40%		Study: Eur J Radiol. 2006 Apr;58(1):27-40. PMID: 16413726
Leukocytosis	Sensitivity = 40%		Study: Eur J Radiol. 2006 Apr;58(1):27-40. PMID: 16413726