Diekhoff Torsten, Deppe Dominik
Immanuel Clinic Ruedersdorf, University Hospital of Brandenburg Medical School, Department of Radiology, Seebad 82/83, 15562, Ruedersdorf bei Berlin, Deutschland.
Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Deutschland.
Radiologie (Heidelb). 2025 Jun 25. doi: 10.1007/s00117-025-01478-2.
Inflammatory spinal disorders include infectious spondylodiscitis and noninfectious spondyloarthritis. Their clinical differentiation and distinction from degenerative conditions are crucial.
This review aims to clearly describe infectious and noninfectious spondylitis, highlighting diagnostic and therapeutic challenges.
Analysis of current literature and clinical experience regarding infection pathways, clinical symptoms, and characteristic findings in imaging modalities (magnetic resonance imaging [MRI], computed tomography [CT], X‑ray).
Infectious spondylodiscitis typically arises through hematogenous or iatrogenic routes, predominantly affecting older patients and presenting specific changes detectable by MRI and CT. Noninfectious spondylarthritis, such as axial spondyloarthritis, typically manifests as enthesitis with characteristic structural lesions. MRI is highly sensitive in identifying active inflammatory lesions, while CT and X-ray are advantageous for visualizing chronic structural changes.
Diagnosing inflammatory spinal disorders remains challenging and requires a combination of clinical and imaging findings. Unified definitions and standardized diagnostic procedures are essential to minimize incorrect assessment and facilitate targeted therapy.
炎性脊柱疾病包括感染性脊椎椎间盘炎和非感染性脊柱关节炎。它们与退行性疾病的临床鉴别至关重要。
本综述旨在清晰描述感染性和非感染性脊柱炎，突出诊断和治疗方面的挑战。
分析当前关于感染途径、临床症状以及影像学检查方法（磁共振成像[MRI]、计算机断层扫描[CT]、X线）特征性表现的文献和临床经验。
感染性脊椎椎间盘炎通常通过血行或医源性途径发生，主要影响老年患者，并呈现出MRI和CT可检测到的特定变化。非感染性脊柱关节炎，如轴性脊柱关节炎，通常表现为附着点炎并伴有特征性结构病变。MRI在识别活动性炎性病变方面高度敏感，而CT和X线在显示慢性结构变化方面具有优势。
诊断炎性脊柱疾病仍然具有挑战性，需要结合临床和影像学表现。统一的定义和标准化的诊断程序对于尽量减少错误评估和促进靶向治疗至关重要。
