Bone Scan Spondylodiscitis

            35 y/o, male, with 3 week back pain and intermitent fever. The  Tc99m MDP bone scan showed increase bone uptake in T11-T12 but it wasnt clear to show  vertebral body involvement. SPECT confirmed intense increase uptake in  the vertebral bodies. Note "sandwich appearance". (arrow).
Infectious spondylodiscitis was confirmed surgically. Patient underwent immediate debridement of the focus, with decompression, stabilization and antibiotic therapy.
(Prepared by Dr Gabriel Castro )

            Often the signs and symptoms of spondylodiscitis are vague and therefore the diagnosis may be delayed. Radiographic changes are inespecific and do not usually appear until two weeks after infection (1). The most frequent disease germs are Staphylococcus aureus (60%), Enterobacter (30%), more rarely Escherichia coli, Salmonella, Pseudomonas aeruginosa and Klebsiella pneumoniae (2).
Bone scintigraphy is a valuable diagnostic (90% sensitivity) procedure for discitis, with earlier detection than plain radiography  and similar initial detection to that of computed tomography. Single photon emission computed tomographic imaging increases diagnostic specificity (3).
 

References:
1) Nolla-Solé J et al. Role of technetium-99m diphosphonate and gallium-67 citrate bone scanning in the early diagnosis of infectious spondylodiscitis. A comparative study. Ann Rheum Dis 1992; 51: 665-667.
2) Stanislaw Pilecki et al.The role of radioisotopic methods in imaging of intervertebral disc inflammation in children. Nucl Med Rev 2006 Vol. 9, No. 1, pp. 72-76.
3) Choong K,Monaghan P.Role of bone scintigraphy in the early diagnosis of discitis. Ann Rheum Dis. 1990 Nov;49(11): 932-4. 
 

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