A 68-year-old woman presents with 2 months of back pain and weight loss. MRI shows destruction of two adjacent thoracic vertebral bodies with collapse, a paravertebral soft tissue mass, but clear preservation of the intervening intervertebral disc. Which diagnosis does this pattern favour?

• A Pyogenic spondylodiscitis
• B Tuberculous spondylitis ✓
• C Metastatic vertebral disease
• D Multiple myeloma

Explanation

Preservation of the disc space despite adjacent vertebral body destruction is characteristic of tuberculous spondylitis, because Mycobacterium tuberculosis lacks the proteolytic enzymes that destroy cartilage early. Pyogenic infection almost always involves and narrows the disc early. Metastases and myeloma destroy vertebral bodies and pedicles but do not typically produce a large contiguous paravertebral abscess crossing two bodies while sparing the disc.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.