Infectious spondylitis is a rare but increasingly recognized condition involving infectious lesions of the spine. It can affect patients of all ages and is typically caused by bacterial, fungal, or other pathogens. The infection commonly targets the vertebral bodies and intervertebral discs. Early symptoms of infectious spondylitis are often nonspecific, making it challenging to differentiate from other spinal disorders such as tumors, degenerative diseases, or other types of infections. As the condition can progress rapidly, early diagnosis and intervention are crucial to improving patient outcomes.

Imaging plays a critical role in the early diagnosis of infectious spondylitis. Magnetic resonance imaging is considered the gold standard due to its superior ability to visualize soft tissue structures and assess the extent of infection. CT imaging and nuclear medicine scans also provide valuable information in certain clinical scenarios, particularly for evaluating bony involvement and detecting occult infection. However, imaging findings in infectious spondylitis can overlap with those of other spinal conditions, making differential diagnosis essential for accurate identification. This study explores the advantages and limitations of different imaging modalities in diagnosing infectious spondylitis, focusing on their ability to suggest the possible etiology, determine the severity of the disease, and guide treatment decisions. Additionally, the relationship between imaging characteristics and clinical symptoms is examined to offer clinicians a systematic approach to improve diagnostic accuracy.

Early and accurate diagnosis of infectious spondylitis is critical for preventing long-term complications. Imaging techniques, especially MRI, are invaluable tools for clinicians in identifying this condition, assessing its extent, and guiding treatment. Improved understanding of the imaging features associated with infectious spondylitis is essential for more accurate diagnosis and treatment planning.

Neuroimaging is crucial for evaluating the craniocervical junction (CCJ), where pathologies are categorized into traumatic and nontraumatic. While traumatic conditions are more prevalent, nontraumatic abnormalities, though less common, carry significant morbidity and mortality and present a diagnostic challenge due to their diverse differential diagnoses. Nontraumatic CCJ abnormalities often necessitate careful diagnosis and management. Imaging plays a key role in identifying and characterizing these conditions, aiding clinical decisions. Nontraumatic CCJ abnormalities include various conditions, such as congenital anomalies, tumors, inflammatory conditions, degenerative changes, and infections. This review highlights the imaging features of common nontraumatic CCJ abnormalities, emphasizing key imaging characteristics for differentiation.

Spondylodiscitis is an infection of the intervertebral disc, the adjacent vertebral body, and/or contiguous structures due to the introduction of infectious agent, usually by the hematogenous route. Imaging is crucial in assessing bacterial and tubercular spondylodiscitis, as well as their associated complications. Magnetic resonance imaging in particular can clearly depict osteo-structural changes in the vertebral body and the associated disc, as well as any soft-tissue complications, such as paravertebral abscess and/or epidural abscess, improving disease characterization and helping to recognize the agent involved. Nevertheless, other non-infectious diseases may mimic imaging appearances of spondylodiscitis and one should be aware of these conditions when interpreting MR images, which include Modic type I degenerative changes, ankylosing spondylitis, acute Schmorl's node, porotic fractures, and spinal neuropathy arthropathy. This pictorial review aims at describing imaging findings of bacterial and non-bacterial spondylodiscitis, complications, and those pathologies that mimic these infections.

We present the case of a 26-year-old male with severe spinal tuberculosis of the thoracolumbar region. The patient suffered from worsening back pain over five years, initially responding to over-the-counter analgesics. Despite being proposed surgery in 2019, the patient refused the intervention and subsequently experienced significant disease progression.

Upon re-presentation in 2022, mild involvement of the T12-L1 vertebrae was recorded by imaging, leading to a percutaneous needle biopsy which confirmed tuberculosis. Despite undergoing anti-tuberculous therapy for one year, the follow-up in 2024 revealed extensive infection from T10 to S1, with large psoas abscesses and a pseudo-tumoral mass of the right thigh. The patient was ultimately submitted to a two-stage surgical intervention: anterior resection and reconstruction of T11-L1 with an expandable cage, followed by posterior stabilization from T8-S1.

Postoperative recovery was uneventful, with significant pain relief and no neurological deficits. The patient was discharged on a continued anti-tuberculous regimen and remains under close surveillance.

This paper presents details on the challenges of diagnosis and management of severe spinal tuberculosis, with emphasis on the importance of timely intervention and multidisciplinary care.

In this report, we present a progressively enlarging, degenerative, intraspongious/intravertebral herniated nucleus pulposus, also referred to as a "Schmorl's node," in a 65-year-old patient with a history of prostate cancer. The patient initially presented to our orthopedic oncology clinic for the evaluation of lytic-appearing lesions involving the L4 and L5 vertebral bodies. He had been diagnosed with prostate cancer approximately four years prior and had been previously treated with prostatectomy. During evaluation for symptoms of neurogenic claudication, computed tomography (CT) demonstrated a hypodense lesion in the L5 vertebral body, which demonstrated mildly increased uptake in the left side of L5 on technetium pyrophosphate nuclear scintigraphy and 18 fluorine fluorodeoxyglucose positron emission tomography-CT scan. CT-guided fine-needle aspiration (FNA) of the lesion was performed and demonstrated no neoplastic findings. He underwent an L4-L5 microscopic unilateral laminotomy with bilateral decompression. However, his neurogenic claudication gradually returned, and he presented to his spine surgeon for further evaluation. Repeat CT of the lumbar spine demonstrated marked interval expansion of the erosive L5 lesion with poorly defined margins as well as a hypodense, erosive lesion in the left side of L4. The patient underwent a repeat FNA, along with a CT-guided core needle biopsy of the lesion at the outside facility which yielded a non-diagnostic specimen. After an extensive discussion with the patient, the decision was ultimately made to proceed with an open biopsy of the L5 lesion with partial L5 corpectomy via left-sided transpedicular approach and L4-S1 decompression and instrumented posterolateral spinal fusion. The primary purpose of the operation was to remove material from the lesion, directly visualize it, and have ample tissue for histopathological analysis. Based on these intraoperative findings and subsequent final histopathologic evaluation, the lesion was definitively diagnosed as a large, aggressive, intraspongious/intravertebral herniated nucleus pulposus. While the differentiation of non-neoplastic conditions, such as a Schmorl's node, from osseous metastatic spine disease can be elusive, it is essential for the appropriate management of patients with a history of malignancy.

Malassezia restricta, a lipophilic and lipodependent yeast belonging to the basidiomycetes group, is an opportunistic fungal pathogen associated with various skin diseases, including seborrheic dermatitis and dandruff. Typically, Malassezia infection in neonates manifests as fungemia or hematogenous dissemination to the bone or lungs. However, vertebral osteomyelitis caused by these fungi is rarely reported owing to non-specific clinical presentations and laboratory/imaging findings. The Pathogen Metagenomics Sequencing (PMseq) technique enables direct high-throughput sequencing of infected specimens, facilitating the rapid and accurate detection of all microorganisms in clinical samples through comprehensive reports.

A 52-year-old male was admitted to our hospital on July 20, 2022 with a 3-month history of ambulatory difficulties and localized low back pain. Magnetic Resonance Imaging (MRI) examination of the spinal column revealed irregular bone destruction affecting the L2, L3, and L5 vertebral bodies. Additionally, low T1 and high T2 intensity lesions were observed at the intervertebral discs between L3 and L5. The presumptive diagnosis of tuberculous spondylitis was made based on the imaging findings, despite negative results in all mycobacterium tests. However, the patient exhibited no improvement after receiving regular anti-tuberculosis treatment for 3 months. Subsequent MRI revealed an expansive abnormal signal within the vertebral body, leading to progressive bone destruction. The absence of spinal tuberculosis or other infective microorganisms was confirmed through culture from blood and pathological tissue from the L4 vertebral body. Subsequently, PMseq was performed on the specimens, revealing M. restricta as the predominant pathogen with the highest relative abundance value. The pathological examination revealed the presence of fungal mycelium in the L4 vertebral body, with positive findings on periodic Schiff-methenamine and periodic acid-Schiff staining. The anti-tuberculosis treatment was discontinued, and an antifungal combination of fluconazole and voriconazole was administered. All symptoms were resolved after 7 consecutive months of treatment, and the patient was able to ambulate autonomously. Vertebral lesions were reduced on MRI during the 13-month follow-up.

M. restricta is not a commonly recognized pathogen associated with infectious vertebral osteomyelitis. However, PMseq can aid in diagnosis, timely treatment, and decision making for some non-specific infectious diseases.

BACKGROUND Reconstruction surgery using titanium vertebral body replacements aids in spinal stability after damage. Functional evaluation includes Nurick and ASIA grading systems. This study compares outcomes of single and double-level corpectomy in patients treated with thoracolumbar reconstruction. MATERIAL AND METHODS Records of 16 patients who underwent vertebral reconstruction with expandable cages after single (n=9) and double (n=8) corpectomy were analyzed retrospectively. Thoracal and lumbar cases were approached posteriorly (n=14). Clinical evaluation was performed by neurological examination, Nurick Scale, American Spinal Injury Association (ASIA) Neurological Scores, and Visual Analog Scale (VAS). Preoperative and postoperative 3-month scores were recorded. Radiological evaluation was performed by calculation of regional angulation and postoperative recovery of vertebral body height. RESULTS Preoperatively, 2 patients had no motor or functional sensory deficits (ASIA grade E) and 6 patients were ASIA grade D. Immediately after surgery, 4 of the ASIA grade D patients improved to ASIA grade E, while 2 patients remained ASIA grade D during follow-up. Four patients were ASIA grade A; their conditions showed no improvement postoperatively. Preoperative and postoperative 3-month Nurick grade was statistically significant (P=0.022). Postoperative Cobb angle improved by a mean of 5.4° (P=0.001). Improvement by at least 1 grade in neurological recovery was observed in 6 (38%) of the cases. Pain scores analyzed using the VAS changed from a mean of 7 to a mean of 2.63 (P<0.001). CONCLUSIONS In our experience, expandable cages are useful in the restoration of different pathologies of the thoracolumbar trunk with low complication and revision rates. With expandable cages it is possible to achieve restoration of the Cobb angle, improvement in Nurick Grade and effective pain palliation.

Introduction: Symptomatic acute metastatic spinal epidural cord compression (MSCC) is an emergency that requires multimodal attention. However, there is no clear consensus on the appropriate timing for surgery. Therefore, to address this issue, we conducted a systematic review and meta-analysis of the literature to evaluate the outcomes of different surgery timings. Methods: We searched multiple databases for studies involving adult patients suffering from symptomatic MSCC who underwent decompression with or without fixation. We analyzed the data by stratifying them based on timing as emergent (≤24 h vs. >24 h) and urgent (≤48 h vs. >48 h). The analysis also considered adverse postoperative medical and surgical events. The rates of improved outcomes and adverse events were pooled through a random-effects meta-analysis. Results: We analyzed seven studies involving 538 patients and discovered that 83.0% (95% CI 59.0-98.2%) of those who underwent urgent decompression showed an improvement of ≥1 point in strength scores. Adverse events were reported in 21% (95% CI 1.8-51.4%) of cases. Patients who underwent emergent surgery had a 41.3% (95% CI 20.4-63.3%) improvement rate but a complication rate of 25.5% (95% CI 15.9-36.3%). Patients who underwent surgery after 48 h showed 36.8% (95% CI 12.2-65.4%) and 28.6% (95% CI 19.5-38.8%) complication rates, respectively. Conclusion: Our study highlights that a 48 h window may be the safest and most beneficial for patients presenting with acute MSCC and a life expectancy of over three months.

Native vertebral osteomyelitis, also termed spondylodiscitis, is an antibiotic-resistant disease that requires long-term treatment. Without proper treatment, NVO can lead to severe nerve damage or even death. Therefore, it is important to accurately diagnose the cause of NVO, especially in spontaneous cases. Infectious NVO is characterized by the involvement of 2 adjacent vertebrae and intervertebral discs, and common infectious agents include Staphylococcus aureus, Mycobacterium tuberculosis, Brucella abortus, and fungi. Clinical symptoms are generally nonspecific, and early diagnosis and appropriate treatment can prevent irreversible sequelae. Advances in pathologic histologic imaging have led physicians to look more forward to being able to differentiate between tuberculous and septic spinal discitis. Therefore, research in identifying and differentiating the imaging features of these 4 common NVOs is essential. Due to the diagnostic difficulties, clinical and radiologic diagnosis is the mainstay of provisional diagnosis. With the advent of the big data era and the emergence of convolutional neural network algorithms for deep learning, the application of artificial intelligence (AI) technology in orthopedic imaging diagnosis has gradually increased. AI can assist physicians in imaging review, effectively reduce the workload of physicians, and improve diagnostic accuracy. Therefore, it is necessary to present the latest clinical research on NVO and the outlook for future AI applications.