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73 year old man in with back pain for several weeks

Findings:
Lateral thoracic spine. A mid-thoracic intervertebral disc level had been narrowed with destruction of the bone of the adjacent inferior and superior endplates.

Diagnosis: vertebral discitis
Differential Diagnosis:

• Degenerative disk disease
• Discitis
• Compression fractures
• Metastases
• Neuropathic (Charcot) Spine

Pyogenic vertebral osteomyelitis occurs in elderly adults with genitourinary tract infections, patients who are immunocompromised, and intravenous drug abusers. Organisms from genitourinary tract infections ascend the vertebral column by way of the vertebral plexus of Baston, a valveless venous bed that allows retrograde blood flow

In 60% of case, the recovered organisms will be Staphylococcus aureus, in 30% of cases, the organisms will be species of Enterobacteriaceae. In 40% of cases, a remote source of infection will be known (usually genitourinary tract, skin, or respiratory tract).