Fig. 13.

39-year-old man with chronic renal failure on dialysis, with biopsy-proven amyloid spondyloarthropathy involving the lumbar spine. There are disc space narrowing and end-plate desctruction with associated bone marrow edema at L3/4 and L4/5. There is also grade 1 anterolisthesis of L4 over L5 as well as a disc herniation causing severe central canal stenosis at L4/5. From the imaging findings, initially infectious spondylodiscitis was suspected. However, failure to respond to antibiotic therapy prompted biopsy, which was negative for infectious organism and positive for amyloid stain