Differentiation between Tuberculous and Pyogenic Spondylodiscitis: The Role of the Anterior Meningovertebral Ligament in Patients with Anterior Epidural Abscess

Differentiation between tuberculous and pyogenic spondylodiscitis is a diagnostic challenge because imaging often does not reliably distinguish the 2 entities and percutaneous biopsies are often culture-negative. The purpose of this study was to determine whether violation of the anterior meningover...

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Bibliographic Details
Published in:American journal of neuroradiology : AJNR 2020-02, Vol.41 (2), p.364-368
Main Authors: Strauss, S B, Gordon, S R, Burns, J, Bello, J A, Slasky, S E
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Child
Cohort Studies
Diagnosis, Differential
Discitis - diagnosis
Discitis - microbiology
Discitis - pathology
Epidural Abscess - diagnosis
Epidural Abscess - microbiology
Epidural Abscess - pathology
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Retrospective Studies
Spine
Tuberculosis - complications
Tuberculosis - diagnosis
Tuberculosis - pathology
Young Adult
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Summary:Differentiation between tuberculous and pyogenic spondylodiscitis is a diagnostic challenge because imaging often does not reliably distinguish the 2 entities and percutaneous biopsies are often culture-negative. The purpose of this study was to determine whether violation of the anterior meningovertebral ligament in the setting of anterior epidural abscess discriminates between these entities. This was a retrospective cohort study of all patients with acid-fast bacillus testing and anterior epidural abscess diagnosed on spinal MR imaging between May 2014 and September 2019, with a final diagnosis of tuberculous or pyogenic spondylodiscitis. Six cases of tuberculous spondylodiscitis (mean age, 45.5 years; 80% male) and 35 cases of pyogenic spondylodiscitis were evaluated (mean age, 56.6 years; 49% male). Demographic characteristics were recorded. Cases were assessed for anterior meningovertebral ligament destruction on MR imaging, as demonstrated by the shape of the epidural collection. Segmental location of the infection was also assessed. Independent 2-sample tests and χ tests of independence were performed to evaluate the significance of the difference between the groups. Five of 6 (83.3%) cases of tuberculous epidural abscess had an intact anterior meningovertebral ligament, and 0/35 cases of pyogenic epidural abscess demonstrated an intact ligament (
ISSN:0195-6108
1936-959X
DOI:10.3174/ajnr.A6370