Bone features reinforce differential diagnosis between tuberculous spondylitis and brucellosis spondylitis

Background Tuberculous spondylitis (TS) and brucellar spondylitis (BS) both cause major long-term morbidity and disability. Though Spondylodiscitis is sensitive to magnetic resonance images, some are difficult to differentiate. This study aims to identify specific bone changes on computed tomography (CT) images, further to differentiate TS from BS. Methods We retrospectively analyzed and enrolled 70 patients with TS and 65 with BS at our hospital from December 2012 to January 2024. Information of bone destruction and formation, vertebral wall integrity, osteosclerosis, and sequestrum on CT images was collected and compared using the chi-square test or t-test. P Results Bone destruction was greater in the TS group compared to the BS group (519.55 mm 2 vs. 316.00 mm 2 , t = 6.01, P 2 = 77.76, P 2 = 134.19, P 2 = 71.30, P 2 = 152.53, P 2 = 102.43, P Conclusions TS and BS exhibit specific features of bone formation, bone destruction, and sequestrum on CT imaging. Our findings indicate that bone features on CT can help clinicians distinguish between two spinal infections.