Findings: AP and lateral views of the lower thoracic spine demonstrate decreased height of the T10/11 intervertebral disc as well as destruction of the superior T11 and inferior T10 end plates.

Diagnosis: Discitis/osteomyelitis at T10/11.

Discussion: In adults the discitis/osteomyelitis complex generally begins with infection of the bone marrow just inferior to the cartilage endplate. In children, however, because there is a direct hematogenous route to the disc, discitis may ensue before the development of osteomyelitis. Routes of contamination in adults include: hematogenous (which is most common), contiguous infection, postoperative/direct implantation.

The osteomyelitis/discitis complex has been termed ineffective spondylitis. Men are affected more frequently than women and the highest frequency occurs in the fifth and sixth decade. A recent history of primary infection (i.e. UTI), instrumentation, or surgical procedure is common. Back pain is the most common presenting complaint, often in association with fevers and elevated WBC.

The most common route of transmission is hematogenously with infection of the subchondral region of a vertebral body with subsequent perforation of the vertebral endplate, contaminating the intervertebral disc. The disc height is then lost and the adjacent vertebral body is infected. After 10-12 weeks regeneration, changes may occur including sclerosis. The most common plain film radiographic abnormalities include loss of intervertebral height in association with loss of the normal endplate definition.

References:
Resnick D. Bones and Joint Imaging, 2nd edition.
W. B. Saunders, Philadelphia. 1996:674-679.

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