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Can Imaging Findings Help Differentiate Spinal Neuropathic Arthropathy from Disk Space Infection? Initial Experience¹

¹ From the Departments of Radiology (S.C.W., M.E.S., L.P.) and Neurosurgery (G.J.P.), Thomas Jefferson University Hospital, 111 S 11th St, Rm 3350G, Philadelphia, PA 19107, and the Wilford Hall Medical Center, Lackland AFB, Tex (W.B.M.) Received March 17, 1999; revision requested May 3; revision received June 14; accepted July 19. Address reprint requests to M.E.S. (e-mail: mark.schweitzer@mail.tju.edu).

PURPOSE: To determine if radiographic, computed tomographic (CT), and magnetic resonance (MR) imaging findings can help differentiate spinal neuropathic arthropathy from disk space infection.

MATERIALS AND METHODS: Imaging studies in 33 patients were evaluated, including 14 patients with spinal neuropathic arthropathy (12 radiographic, seven CT, and six MR studies) and 19 with disk space infection (13 radiographic, nine CT, and 12 MR studies). Potential imaging discriminators, including endplate sclerosis or erosions, osteophytes, spondylolisthesis, facet involvement (narrowing or erosions), vacuum disk, paraspinal soft-tissue mass, joint disorganization, and osseous joint debris, were recorded, as were MR imaging signal intensity and gadolinium-enhancement characteristics.

RESULTS: The most helpful findings for diagnosis of spinal neuropathic arthropathy were vacuum disk on radiographs and CT images, debris on radiographs and CT and MR images, disorganization on radiographs and CT and MR images, facet involvement on radiographs and CT and MR images, spondylolisthesis on CT and MR images, diffuse signal intensity patterns in vertebral bodies on MR images, and rim enhancement of disks on gadolinium-enhanced MR images. Findings that were not helpful included endplate sclerosis and erosions, osteophytes, paraspinal soft-tissue mass, and decreased disk height.

CONCLUSION: Vacuum disk, facet involvement, vertebral body spondylolisthesis, joint disorganization and debris, and gadolinium-enhancement patterns of vertebral bodies and disks may help differentiate spinal neuropathic arthropathy from infection.

Index terms: Computed tomography (CT), comparative studies • Magnetic resonance (MR), comparative studies • Spine, CT, 30.12111 • Spine, diseases, 30.78, 30.821 • Spine, infection, 30.21 • Spine, intervertebral disks, 30.78 • Spine, MR, 30.121411, 30.12143

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