. 2021 Dec 9;25:101742. doi: 10.1016/j.jcot.2021.101742

Table 1.

Mimics of spinal tuberculosis.

Mimics of spinal tuberculosis	Salient features to differentiate it from spinal tuberculosis.
Pyogenic spondylitis (Fig. 13)	Acute onset with shorter duration of history. High fever and constitutional symptoms. Lumbar spine is the most common site. Usually involve ≤2 vertebral bodies. More homogeneous and ill-defined enhancement of involved vertebral bodies <50% vertebral body destruction. Early and severe disc involvement. Paraspinal abscess are infrequent and when present show thick and irregular wall enhancement.¹⁹^,²⁴ Functional MRI, particularly diffusion tensor imaging, and dynamic contrast enhanced MRI, are new emerging techniques used to differentiate pyogenic spondylitis from spinal tuberculosis.²⁶^,²⁷ Razek, and Sherif noted higher mean diffusivity, and lower fractional anisotropy in pyogenic spondylitis, than in spinal tuberculosis.²⁶ Miyamoto and Akagi noted longer maximum contrast index, and higher likelihood of enhanced disc in pyogenic spondylitis, in comparison with spinal tuberculosis.²⁷
Brucellosis	Predilection for lumbar spine. Diffuse vertebral osteomyelitis with preserved vertebral architecture. Gibbus deformity is rare. Osteophyte formation at anterior vertebral end plate (parrot's beak) Facet joint involvement and early disc involvement. Air with in intervertebral disc or vertebral body is characteristic finding in brucellosis. Paraspinal abscess, when present, show thin irregular wall enhancement.²⁴^,²⁵^,²⁸
Andersson's lesion in ankylosing spondylitis	Localized disco-vertebral inflammation or fracture of ankylosed spine. Associated features of ankylosing spondylitis: Syndesmophytes, bamboo spine, facet arthropathy, and bilateral sacroiliitis.²⁴^,²⁵
SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis) syndrome	Multifocal involvement. Anterior vertebral body corner erosions are characteristic finding. Absence of abscess. Extraspinal involvement, particularly skin manifestations are often seen (94%).²⁵^,²⁹
Rheumatoid arthritis	Cervical spine is most common site of spinal involvement. Almost always associated with other features of rheumatoid arthritis, more commonly, peripheral polyarthropathy. Absence of abscess.²⁴^,³⁰
Modic type 1 changes	Lack of clinical features and laboratory findings suggestive of infective etiology, such as fever, and raised white blood cell counts or ESR. Absence of abnormal high signal intensity with in disc. End plate erosion rather than end plate destruction. Absence of paraspinal abscess. Vacuum phenomenon.²⁴^,²⁵^,³¹
Baastrup's disease	Commonly involve L4-L5 spinous process. Approximation of enlarged spinous process. Often associated with degenerative spine changes as loss of disc height, osteophyte formation, spondylosis, and spondylolisthesis.²⁴
Osteoporotic fracture	T2 and T1 hypointense fracture line or trabecular impaction. Relatively preserved marrow signal intensity. Absent paraspinal soft tissue or abscess. Diffuse osteoporotic changes.²⁴
Neuropathic spine	Appropriate clinical history is important, particularly of traumatic spinal cord injury or neurosyphilis. Gas with in the disc, bone sclerosis, large osteophytes, bone fragmentation, and malalignment.²⁴^,²⁵
Metastasis (Fig. 14)	History of malignancy. Thoracic spine is the most common site involved. Single vertebral body or posterior elements involvement favor metastasis. Presence of skip lesion. Destructive bone lesion with preserved disc and sharp endplates. No sequestra formation. Absence of paraspinal or intra-osseus abscess.²⁴^,³²^,³³