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Are You Mocking Me? Spine Infection and its Mimickers 2014

Category General Spine Laura Gillihan, MD Kriti Gandhi, BSc Felix Gonzalez , MD Theresa Kouo, MD Umran Ashruf, MD Purpose Given the potential rapid clinical progression of spine infections, early diagnosis and treatment is imperative to decreasing morbidity and mortality. Recognizing the typical and atypical appearances of spine infection and differentiating infectious from non-infectious etiologies is essential for the radiologist as failure to do so can prolong the diagnosis and treatment as well as result in unnecessary procedures. The purpose of this exhibit is to illustrate the classic patterns of spine infection and subsequently depict imaging mimics of spine infection and useful distinguishing features. Materials & Methods Cases of typical and atypical spinal infection and infection mimics were retrospectively reviewed over a 12 month period. Clinical correlation was made with patient histories, clinical work-up and biopsy results when available. Results Typical and atypical spine infections including discitis/osteomyelitis, septic arthritis, epidural abscess were reviewed. Comparison was made with mimics including Modic type I degenerative , amyloid, ankylosing spondylitis, hemodialysis-related spondyloarthropathy, tumor, and spinal neuropathy. Conclusion Infection is a common cause of spine disease that must be recognized early to avoid permanent disability. Radiologists must be familiar with the typical and atypical appearances of spine infection as well as its mimics to expedite rapid diagnosis and initiation of therapy. References 1. Tali ET. Spinal infections Eur J Radiol. 2004 May;50(2):120-33. 2. Mellado J et al. MR imaging of spinal infection: atypical features, interpretative pitfalls and potential mimickers. Eur Radiol. 2004 Nov;14(11):1980-9. 3. Hong S et al. MR Imaging Assessment of the Spine: Infection or an Imitation? Radiographics. 2009 Mar-Apr;29(2):599-612. 4. McHenry MC, Easely KA, Locker GA. Vertebral Osteomyelitis: Long-Term Outcome for 253 Patients from 7 Cleveland-Area Hospitals. Clin Infect Dis. (2002) 34 (10): 1342-1350. doi: 10.1086/340102 5. Govender S. Spinal infections. J Bone Joint Surg Br. 2005 Nov;87(11):1454-8. 6. Carreyon LY, Puno RM, Dimar JR 2nd, Glassman SD, and Johnson JR. Perioperative Complications of Posterior Lumbar Decompression and Arthrodesis in Older Adults. J Bone Joint Surg Am. 2003 Nov;85-A(11):2089-92. 7. Grivé E, Rovira A, Capellades J, Rivas A, and Pedraza S. Radiologic findings in two cases of acute Schmörl's nodes. Am J Neuroradiol. 1999 Oct;20(9):1717-21.