Seminars in ultrasound, CT, and MR
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MRI with intravenous contrast has recently become the imaging modality of choice in the evaluation of patients developing recurrent back pain or symptoms following laminectomy and/or discectomy. The normal postoperative appearance is important to recognize because a number of changes occur normally throughout the healing period. ⋯ Disc space infection, although uncommon, is a critical diagnosis, but can be confused with degenerative end plate changes. Arachnoiditis and spinal stenosis also show characteristic imaging findings.
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Infective spondylitis, the combined infection of the osseous vertebral structures and disc space, constitutes 2% to 4% of all cases of osteomyelitis, and is increasing in prevalence. Differences in clinical and imaging presentation between children and adults are explained by developmental anatomic differences. ⋯ However, MRI is emerging as the most sensitive and specific modality for early detection of pyogenic and nonpyogenic infections and their complications, as well as in follow-up evaluation. Degenerative disc disease, seronegative spondyloarthropathies, and spondyloarthropathy associated with long-term hemodialysis may mimic the imaging abnormalities of infective spondylitis.