Which single feature on imaging best supports tuberculous spondylodiscitis over acute pyogenic spondylodiscitis?

• A Early complete destruction of the intervertebral disc
• B Diffuse marrow oedema on short tau inversion recovery sequences
• C Marked subchondral sclerosis of adjacent end plates
• D Large paravertebral abscess with relative sparing of the disc and minimal reactive sclerosis ✓

Explanation

Tuberculous spondylitis spreads subligamentously beneath the anterior longitudinal ligament, forming large paravertebral or psoas collections while destroying the disc relatively slowly, and it provokes little reactive new bone or sclerosis. Pyogenic infection contains potent proteolytic enzymes that destroy the disc rapidly and induces prominent sclerosis, making options A and C features of bacterial disease. Diffuse marrow oedema occurs in any infective spondylitis and does not discriminate between them.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.