The most common spine infection, spondylodiskitis centered on a single disk level with adjacent bone inflammation and destruction, is easily diagnosed. But as discussed in this article, a number of presentations are difficult to diagnose at first presentation. After a short introduction and review of imaging modalities, specific imaging manifestations of spine infection and their differential diagnoses are described.

This review looks at inflammatory end-plate changes, epidural collection, posterior element changes, paravertebral inflammation, and isolated disk signal change. The differential diagnoses are listed. A sizable number of cases, many of which were initially misdiagnosed, are described to illustrate pertinent points.

The most important lesson is to perform short-term follow-up cross-sectional imaging if a diagnosis of infection is considered but cannot be clearly established.

Received: 23 January 2026

Accepted: 07 February 2026

Article published online:
27 March 2026

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