Case Author(s): Charles Pringle, M.D./ Tom R. Miller M.D., Ph.D. , 08/17/95 . Rating: #D2, #Q3

Diagnosis: Discitis with osteomyelitis

Brief history:

63-year old woman with one- month history of lower back pain.


Anterior and posterior whole body delayed images

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View second image(mr). Sagittal unenhanced and enhanced M.R.I. of the lumbar spine

Full history/Diagnosis is available below

Diagnosis: Discitis with osteomyelitis

Full history:

63-year old woman with sudden onset of lower back pain approximately one month ago after playing golf. The pain has continued to increase in severity. Previous lumbar spine radiographs were normal except for degenerative change.


20.2 mCi Tc-99m MDP i.v.


Delayed whole body images show focal, intensely increased uptake at L2-3. Plain radiographs demonstrate demineralization and destruction of the anterior aspect of the L2 inferior endplate and L3 superior endplate with probable decrease in disc space at this level.


Discitis in the adult is generally due to blood-born bacterial invasion of the disc from adjacent endplates via communicating vessels. The most common bacterial agent is Staphylococcus aureus, gram-negative rods in intravenous drug abusers, and, increasingly, tuberculosis. As in this cases, the plain films are often negative early in the course of the process. Later, there is destruction of adjacent endplates, finally with endplate sclerosis during healing. Bone scintigraphy is a sensitive method for evaluating possible discitis.


An MRI examination of the lumbosacral spine was performed on the same day as the bone scintigraphy. On T1 weighted images, there is low signal in the adjacent areas of the L2 and L3 vertebral bodies and the L2-L3 disc space. These same areas enhance after gadolinium administration. There is also increased signal in the same area on T2- weighted images. Additionally, there is a small epidural inflammatory mass at the L2-L3 level, which is anterior to the spinal cord. The MRI findings were consistent with L2-L3 discitis and adjacent osteomyelitis. The next day, the patient underwent a fluoroscopically guided disc-space biopsy at the L2-L3 level, which subsequently grew Streptococcus viridans. The patient was treated with intravenous antibiotics.

Major teaching point(s):

The increased activity involving two adjacent vertebral bodies on bone scintigraphy is highly suggestive of discitis.

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Spine and Contents, Category:Inflammation,Infection)

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Case number: bs032

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