Spinal infections can be considered as a spectrum of diseases that include spondylitis, discitis, spondylodiscitis, epidural infections and pyogenic facet arthropathy. Inflammation can be caused by pyogenic, granulomatous, autoimmune, idiopathic and iatrogenic conditions.

The majority of spinal infections are caused by bacterial and fungal pathogens. Bacterial spondylodiscitis is much more common than fungal agents. Lumbar vertebra is the most common site of pyogenic spondylodiscitis. Tuberculous spondylodiscitis is often seen in the thoracolumbar junction, while brucellar spondylodiscitis affects the lower lumbar region more. Paravertebral and epidural abscesses may also accompany tuberculous spondylodiscitis.

MRI is the main imaging modality in spinal infections. It is the most sensitive imaging method for the evaluation of early osteomyelitis. The earliest imaging finding is bone marrow edema. Depending on the edema, they are seen as low signal areas on T1-weighted images and high signal areas on T2-weighted images. They show contrast enhancement on post-contrast images.

Facet joint infections are rarely seen in isolation. Imaging may show subchondral bone loss along with thickening of the periarticular soft tissue and capsule.

Modic type 1 degeneration, which we frequently see in our clinical practice, can also be confused with spinal infection findings. Although the clinical situation helps in the differentiation, the presence of accompanying degenerative findings also has an important place in the differential diagnosis.