51
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The Tree That Hides the Forest. J Belg Soc Radiol 2018; 102:38. [PMID: 30039050 PMCID: PMC6032465 DOI: 10.5334/jbsr.1539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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52
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Papel de la cirugía en el tratamiento de las espondilodiscitis espontáneas: experiencia en 83 casos consecutivos. Neurocirugia (Astur) 2018; 29:64-78. [DOI: 10.1016/j.neucir.2017.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/18/2017] [Accepted: 09/03/2017] [Indexed: 12/17/2022]
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53
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Tuberculous Spondylitis: A Report of Different Clinical Scenarios and Literature Update. Case Rep Med 2017; 2017:4165301. [PMID: 29391868 PMCID: PMC5748127 DOI: 10.1155/2017/4165301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 11/05/2017] [Indexed: 12/17/2022] Open
Abstract
Tuberculosis is still one of the most important health problems in the world. In developed countries, the proportion of extrapulmonary tuberculosis cases is increasing. Nowadays tuberculous spondylitis, also known as Pott disease, is a rare clinical condition but can cause severe vertebral and neurological sequelae that can be prevented with an early correct diagnosis. The aim of this paper is to increase awareness of tuberculous spondylitis in modern times, describing three different cases and discussing its best diagnostic and therapeutic approach based on the current literature.
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54
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Mavrogenis AF, Megaloikonomos PD, Igoumenou VG, Panagopoulos GN, Giannitsioti E, Papadopoulos A, Papagelopoulos PJ. Spondylodiscitis revisited. EFORT Open Rev 2017; 2:447-461. [PMID: 29218230 PMCID: PMC5706057 DOI: 10.1302/2058-5241.2.160062] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Spondylodiscitis may involve the vertebral bodies, intervertebral discs, paravertebral structures and spinal canal, with potentially high morbidity and mortality rates. A rise in the susceptible population and improved diagnosis have increased the reported incidence of the disease in recent years. Blood cultures, appropriate imaging and biopsy are essential for diagnosis and treatment. Most patients are successfully treated by conservative means; however, some patients may require surgical treatment. Surgical indications include doubtful diagnosis, progressive neurological deficits, progressive spinal deformity, failure to respond to treatment, and unresolved pain.
Cite this article: EFORT Open Rev 2017;2:447–461. DOI: 10.1302/2058-5241.2.160062
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Affiliation(s)
- Andreas F Mavrogenis
- Attikon General University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Panayiotis D Megaloikonomos
- Attikon General University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Vasileios G Igoumenou
- Attikon General University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Georgios N Panagopoulos
- Attikon General University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Efthymia Giannitsioti
- Attikon General University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Antonios Papadopoulos
- Attikon General University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Panayiotis J Papagelopoulos
- Attikon General University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Kritsaneepaiboon S, Andres MM, Tatco VR, Lim CCQ, Concepcion NDP. Extrapulmonary involvement in pediatric tuberculosis. Pediatr Radiol 2017; 47:1249-1259. [PMID: 29052770 DOI: 10.1007/s00247-017-3867-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 02/23/2017] [Accepted: 04/09/2017] [Indexed: 12/17/2022]
Abstract
Tuberculosis in childhood is clinically challenging, but it is a preventable and treatable disease. Risk factors depend on age and immunity status. The most common form of pediatric tuberculosis is pulmonary disease, which comprises more than half of the cases. Other forms make up the extrapulmonary tuberculosis that involves infection of the lymph nodes, central nervous system, gastrointestinal system, hepatobiliary tree, and renal and musculoskeletal systems. Knowledge of the imaging characteristics of pediatric tuberculosis provides clues to diagnosis. This article aims to review the imaging characteristics of common sites for extrapulmonary tuberculous involvement in children.
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Affiliation(s)
- Supika Kritsaneepaiboon
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Thailand.
| | - Mariaem M Andres
- Institute of Radiology, St. Luke's Medical Center, 32nd Avenue corner 5th Street, Bonifacio Global City, 1634, Taguig City, Philippines
| | - Vincent R Tatco
- Institute of Radiology, St. Luke's Medical Center, 32nd Avenue corner 5th Street, Bonifacio Global City, 1634, Taguig City, Philippines
| | - Cielo Consuelo Q Lim
- Institute of Radiology, St. Luke's Medical Center, 279 E. Rodriquez Sr. Boulevard, 1102, Quezon City, Philippines
| | - Nathan David P Concepcion
- Institute of Radiology, St. Luke's Medical Center, 32nd Avenue corner 5th Street, Bonifacio Global City, 1634, Taguig City, Philippines
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56
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Ono H, Kishi S, Inagaki T, Mizusawa M, Kishi F, Yoshimoto S, Tamaki M, Minato M, Ueda S, Murakami T, Nagai K, Abe H, Doi T. Shunt Nephritis and Pyogenic Spondylitis With a Positive PR3-ANCA Associated With Chronically Infected Ventriculoatrial Shunt. Kidney Int Rep 2017; 2:774-778. [PMID: 29142993 PMCID: PMC5678644 DOI: 10.1016/j.ekir.2017.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Hiroyuki Ono
- Department of Nephrology, Tokushima University Hospital, Tokushima, Japan
| | - Seiji Kishi
- Department of Nephrology, Tokushima University Hospital, Tokushima, Japan
| | - Taizo Inagaki
- Department of Nephrology, Tokushima University Hospital, Tokushima, Japan
| | - Masako Mizusawa
- Division of Medical Microbiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Fumi Kishi
- Department of Nephrology, Tokushima University Hospital, Tokushima, Japan
| | - Sakiya Yoshimoto
- Department of Nephrology, Tokushima University Hospital, Tokushima, Japan
| | - Masanori Tamaki
- Department of Nephrology, Tokushima University Hospital, Tokushima, Japan
| | - Masanori Minato
- Department of Nephrology, Tokushima University Hospital, Tokushima, Japan
| | - Sayo Ueda
- Department of Nephrology, Tokushima University Hospital, Tokushima, Japan
| | - Taichi Murakami
- Department of Nephrology, Tokushima University Hospital, Tokushima, Japan
| | - Kojiro Nagai
- Department of Nephrology, Tokushima University Hospital, Tokushima, Japan
| | - Hideharu Abe
- Department of Nephrology, Tokushima University Hospital, Tokushima, Japan
| | - Toshio Doi
- Department of Nephrology, Tokushima University Hospital, Tokushima, Japan
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Letter to the Editor concerning "New classification for the treatment of pyogenic spondylodiscitis: validation study on a population of 250 patients with a follow-up of 2 years" by Enrico Pola et al. Eur Spine J (2017) doi:10.1007/s00586-017-5043-5. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:2475. [PMID: 28593378 DOI: 10.1007/s00586-017-5160-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
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Kumar Y, Gupta N, Chhabra A, Fukuda T, Soni N, Hayashi D. Magnetic resonance imaging of bacterial and tuberculous spondylodiscitis with associated complications and non-infectious spinal pathology mimicking infections: a pictorial review. BMC Musculoskelet Disord 2017; 18:244. [PMID: 28583099 PMCID: PMC5460517 DOI: 10.1186/s12891-017-1608-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/30/2017] [Indexed: 12/16/2022] Open
Abstract
Magnetic resonance (MR) imaging plays an important role in the evaluation of bacterial and tuberculous spondylodiscitis and associated complications. Owing to its high sensitivity and specificity, it is a powerful diagnostic tool in the early diagnosis of ongoing infections, and thus provides help in prompt initiation of appropriate, therapy which may be medical or surgical, by defining the extent of involvement and detection of complications such as epidural and paraspinal abscesses. More specifically, MR imaging helps in differentiating bacterial from tuberculous infections and enables follow up of progression or resolution after appropriate treatment. However, other non-infectious pathology can demonstrate similar MR imaging appearances and one should be aware of these potential mimickers when interpreting MR images. Radiologists and other clinicians need to be aware of these potential mimics, which include such pathologies as Modic type I degenerative changes, trauma, metastatic disease and amyloidosis. In this pictorial review, we will describe and illustrate imaging findings of bacterial and tuberculous spondylodiscitis, their complications and non-infectious pathologies that mimic these spinal infections.
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Affiliation(s)
- Yogesh Kumar
- Department of Radiology, Yale New Haven Health System at Bridgeport Hospital, 267 Grant Street, Bridgeport, 06610 CT USA
| | - Nishant Gupta
- Department of Radiology, St. Vincent’s Medical Center, 2800 Main Street, Bridgeport, 06606 CT USA
| | - Avneesh Chhabra
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, 75390 TX USA
| | - Takeshi Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Neetu Soni
- Department of Neuroradiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, U.P India
| | - Daichi Hayashi
- Department of Radiology, Yale New Haven Health System at Bridgeport Hospital, 267 Grant Street, Bridgeport, 06610 CT USA
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, 02118 MA USA
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Sparacello VS, Roberts CA, Kerudin A, Müller R. A 6500-year-old Middle Neolithic child from Pollera Cave (Liguria, Italy) with probable multifocal osteoarticular tuberculosis. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2017; 17:67-74. [PMID: 28521913 DOI: 10.1016/j.ijpp.2017.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 01/11/2017] [Accepted: 01/14/2017] [Indexed: 06/07/2023]
Abstract
Clear skeletal evidence of prehistoric tuberculosis (TB) is rare, especially in children. We describe and differentially diagnose the pathological changes displayed by a five-year-old child, Pollera 21 (PO21) dated to the Middle Neolithic of Liguria (Italy), or 5740±30 BP (Beta-409341; 6635-6453cal BP, 2σ, OxCal 4.2). PO21 shows a number of osteoarticular lesions, mainly of a lytic nature with very little bone proliferation: the vertebral column, the shoulder and pelvic girdles, and the ribcage are involved. Given the nature and pattern of the lesions, we propose a diagnosis of multifocal (or multiple) bone TB. Attempts to detect TB aDNA through molecular analysis gave negative results, but this alone is not sufficient to prove that PO21 was not infected with TB. The lesions observed in PO21 share similarities with other published evidence, such as spinal and joint involvement, and disseminated cyst-like lesions. Conversely, PO21 does not show diffuse bone deposition, such as hypertrophic osteoarthropathy (HOA) or endocranial modifications such as serpens endocrania symmetrica (SES). PO21 adds to our knowledge of patterns of TB manifestation in archaeological skeletal remains, which is especially important considering the variability in types and patterns of osteoarticular lesions seen today in people with TB.
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Affiliation(s)
- Vitale S Sparacello
- Department of Archaeology, Durham University, Durham DH1 3LE, United Kingdom; UMR5199 PACEA, Univ. Bordeaux, Batiment B8, Avenue Geoffroy Saint Hilaire, CS 50023, 33615, Pessac Cedex, France.
| | - Charlotte A Roberts
- Department of Archaeology, Durham University, Durham DH1 3LE, United Kingdom
| | - Ammielle Kerudin
- Manchester Institute of Biotechnology, Faculty of Life Sciences, The University of Manchester, 131 Princess Street, Manchester M1 7DN, United Kingdom
| | - Romy Müller
- Manchester Institute of Biotechnology, Faculty of Life Sciences, The University of Manchester, 131 Princess Street, Manchester M1 7DN, United Kingdom
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Sheikh AF, Khosravi AD, Goodarzi H, Nashibi R, Teimouri A, Motamedfar A, Ranjbar R, Afzalzadeh S, Cyrus M, Hashemzadeh M. Pathogen Identification in Suspected Cases of Pyogenic Spondylodiscitis. Front Cell Infect Microbiol 2017; 7:60. [PMID: 28337426 PMCID: PMC5343039 DOI: 10.3389/fcimb.2017.00060] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 02/13/2017] [Indexed: 12/19/2022] Open
Abstract
Pyogenic spinal infection continues to represent a worldwide problem. In approximately one-third of patients with pyogenic spondylodiscitis, the infectious agent is never identified. Of the cases that lead to organismal identification, bacteria are more commonly isolated from the spine rather than fungi and parasites. This study applied universal prokaryotic 16S rRNA PCR as a rapid diagnostic tool for the detection of bacterial agents in specimens from patients suspected of pyogenic spondylodiscitis. Gram and Ziehl-Neelsen staining were used as a preliminary screening measure for microbiologic evaluation of patient samples. PCR amplification targeting 16S rRNA gene was performed on DNA extracted from 57 cases including specimens from epidural abscesses, vertebral, and disc biopsies. Positive samples were directly sequenced. MRI findings demonstrated that disc destruction and inflammation were the major imaging features of suspected pyogenic spondylodiscitis cases, as 44 cases showed such features. The most common site of infection was the lumbar spine (66.7%), followed by thoracic spine (19%), the sacroiliac joint (9.5%), and lumbar-thoracic spine (4.8%) regions. A total of 21 samples amplified the 16S rRNA-PCR product. Sanger sequencing of the PCR products identified the following bacteriological agents: Mycobacterium tuberculosis (n = 9; 42.9%), Staphylococcus aureus (n = 6; 28.5%), Mycobacterium abscessus (n = 5; 23.8%), and Mycobacterium chelonae (n = 1; 4.8%). 36 samples displayed no visible 16S rRNA PCR signal, which suggested that non-bacterial infectious agents (e.g., fungi) or non-infectious processes (e.g., inflammatory, or neoplastic) may be responsible for some of these cases. The L3–L4 site (23.8%) was the most frequent site of infection. Single disc/vertebral infection were observed in 9 patients (42.85%), while 12 patients (57.15%) had 2 infected adjacent vertebrae. Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) inflammatory markers were noted in majority of the patients. In conclusion, microbiological methods and MRI findings are vital components for the proper diagnosis of pyogenic spondylodiscitis. Our findings suggest that molecular methods such as clinical application of 16S rRNA PCR and sequencing may be useful as adjunctive diagnostic tools for pyogenic spondylodiscitis. The rapid turnaround time of 16S rRNA PCR and sequencing submission and results can potentially decrease the time to diagnosis and improve the therapeutic management and outcome of these infections. Although S. aureus and M. tuberculosis were the most common causes of pyogenic spinal infections in this study, other infectious agents and non-infectious etiologies should be considered. Based on study results, we advise that antibiotic therapy should be initiated after a definitive etiological diagnosis.
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Affiliation(s)
- Ahmad Farajzadeh Sheikh
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran; Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
| | - Azar D Khosravi
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran; Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
| | - Hamed Goodarzi
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran; Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran; Molecular Biology Research Center, Baqiyatallah University of Medical ScienceTehran, Iran
| | - Roohangiz Nashibi
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran; Department of Infectious Diseases, Razi Teaching Hospital, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
| | - Alireaza Teimouri
- Department of Neurosurgery, Golestan Teaching Hospital, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran; Department of Neurosurgery, Tehran Medical Science Branch, Islamic Azad UniversityTehran, Iran
| | - Azim Motamedfar
- Department of Radiology, Razi Teaching Hospital, Ahvaz Jundishapur University of Medical Sciences Ahvaz, Iran
| | - Reza Ranjbar
- Molecular Biology Research Center, Baqiyatallah University of Medical Science Tehran, Iran
| | - Sara Afzalzadeh
- Department of Infectious Diseases, Razi Teaching Hospital, Ahvaz Jundishapur University of Medical Sciences Ahvaz, Iran
| | - Mehrandokht Cyrus
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences Ahvaz, Iran
| | - Mohammad Hashemzadeh
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran; Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
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Frel M, Białecki J, Wieczorek J, Paluch Ł, Dąbrowska-Thing A, Walecki J. Magnetic Resonance Imaging in Differentatial Diagnosis of Pyogenic Spondylodiscitis and Tuberculous Spondylodiscitis. Pol J Radiol 2017; 82:71-87. [PMID: 28243340 PMCID: PMC5317295 DOI: 10.12659/pjr.899606] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/25/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Infectious spondylodiscitis is characterized by the involvement of two adjacent vertebrae and the intervening disc. Incidence rate of the disease is estimated at 0.4-2 cases per 100000 per year. Staphylococcus aureus is the most common infectious agent causing pyogenic spondylodiscitis. Non-pyogenic infections of the spine are most frequently caused by Mycobacterium tuberculosis, and fungi. Clinical symptoms are nonspecific. Early diagnosis and appropriate treatment can prevent unfavorable irreversible sequela for the patient. Significant developments in techniques of imaging of pathological tissues raised expectations among the clinicians regarding possibility to distinguish between tuberculous spondylodiscitis and pyogenic spondylodiscitis on MR images. The aim of this study was to identify and differentiate between features of tuberculous and pyogenic spondylodiscitis on MR images. MATERIAL/METHODS We performed retrospective analysis of MR images obtained from 34 patients with confirmed spondylodiscitis (18 with pyogenic spondylodiscitis, and 16 with tuberculous spondylodiscitis). Data acquisition was performed using 1.5 T MRI scanners where images were obtained using similar protocols. T2 TIRM and T1-weighted images with and without contrast enhancement were subject to assessment in coronal, axial and sagittal planes. RESULTS Characteristic features of pyogenic spondylodiscitis include: involvement of the lumbar spine, ill-defined paraspinal abnormal contrast enhancement, diffuse/homogeneous contrast enhancement of vertebral bodies, low-grade destruction of vertebral bodies, hyperintense/homogeneous signal from the vertebral bodies on T2 TIRM images. Prevailing features of tuberculous spondylodiscitis included: involvement of the thoracic spine, involvement of 2 or more adjacent vertebral bodies, severe destruction of the vertebral body, focal/heterogeneous contrast enhancement of vertebral bodies, heterogeneous signal from the vertebral bodies on T2 TIRM images, well-defined paraspinal abnormal contrast enhancement, paraspinal and epidural abscesses, meningeal enhancement at the affected spine level. CONCLUSIONS Comparison of MR images of patients diagnosed with pyogenic spondylodiscitis and tuberculous spondylodiscitis allowed identification of individual characteristics for preliminary differentiation between TB and infectious spondylodiscitis and thereby enabling proper treatment.
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Affiliation(s)
- Małgorzata Frel
- Department of Diagnostic Imaging, Gruca Teaching Hospital, Medical Center of Postgraduate Education, Otwock, Poland
| | - Jerzy Białecki
- Adults Orthopaedic Ward, II Orthopaedic Department, Gruca Teaching Hospital, Medical Center of Postgraduate Education, Otwock, Poland
| | - Janusz Wieczorek
- Department of Diagnostic Imaging, Gruca Teaching Hospital, Medical Center of Postgraduate Education, Otwock, Poland
| | - Łukasz Paluch
- Department of Diagnostic Imaging, Gruca Teaching Hospital, Medical Center of Postgraduate Education, Otwock, Poland
| | - Agnieszka Dąbrowska-Thing
- Department of Diagnostic Imaging, Gruca Teaching Hospital, Medical Center of Postgraduate Education, Otwock, Poland
| | - Jerzy Walecki
- Department of Diagnostic Imaging, Gruca Teaching Hospital, Medical Center of Postgraduate Education, Otwock, Poland
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Abstract
STUDY DESIGN Retrospective cross-sectional study. OBJECTIVE To investigate the differences between tuberculous spondylitis (TS) and brucellar spondylitis (BS) on magnetic resonance images (MRI). SUMMARY OF BACKGROUND DATA Both TS and BS are common spinal affections and can cause deformities and permanent neurologic deficiencies without prompt diagnosis and treatment. However, differentiating the types of spondylitis clinically and radiographically is challenging. Despite the diagnosis studies on spine infection throughout the literature, the outcome has not been established. Our study about the different characteristics between TS and BS on MRI may be helpful. METHODS Eighteen patients with TS and 26 with BS were included in this study. MRI images were obtained and analyzed. For statistical analysis, the χ test was performed. Statistical significance was defined as P < 0.05. RESULTS There were statistically significant differences between TS and BS on the MRI images: (i) subligamentous spread to three or more vertebral levels [TS 54% (7/13) vs. BS 8% (1/12)]; (ii) subligamentous spread to fewer than three vertebral levels [23% (3/13) vs. 58% (7/12)]; (iii) thoracic spine involvement [50% (9/18) vs. 4% (1/26)]; and lumbar spine involvement [22% (4/18) vs. 77% (20/26)]; (iv) abnormal signal from the vertebral disc on T2-weighted images [33% (7/21) vs. 85% (30/35)]; (v) focal or fan-shaped hyperintense signals on middle sagittal fat-suppressed weighted images [14% (7/50) vs. 50% (31/62)] and especially fan-shaped hyperintense signal [0% (0/50) vs. 23% (14/62)]; (vi) spinal kyphosis [22% (11/50) vs. 3% (2/62)]; (vii) vertebral collapse [42% (21/50) vs. 2% (1/62)]; (viii) peridiscal bone destruction [22% (11/50) vs. 44% (27/62)]; and (ix) psoas abscesses [6% (3/50) vs. 0% (0/62)]. CONCLUSION MRI is a sensitive imaging technique and can clearly define the different features between TS and BS, so it should be the first choice for imaging in the diagnosis of spondylodiscitis. LEVEL OF EVIDENCE 4.
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Gambhir S, Ravina M, Rangan K, Dixit M, Barai S, Bomanji J. Imaging in extrapulmonary tuberculosis. Int J Infect Dis 2016; 56:237-247. [PMID: 27838445 DOI: 10.1016/j.ijid.2016.11.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 12/17/2022] Open
Abstract
Tuberculosis (TB) remains a major global public health problem, with 1.5 million deaths annually worldwide. One in five cases of TB present as extrapulmonary TB (EPTB), posing major diagnostic and management challenges. Mycobacterium tuberculosis adapts to a quiescent physiological state and is notable for its complex interaction with the host, producing poorly understood disease states ranging from latent infection to active clinical disease. New tools in the diagnostic armamentarium are urgently required for the rapid diagnosis of TB and monitoring of TB treatments, and to gain new insights into pathogenesis. The typical and atypical imaging features of EPTB are reviewed herein, and the roles of several imaging modalities for the diagnosis and management of EPTB are discussed.
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Affiliation(s)
- Sanjay Gambhir
- Sanjay Gandhi Post Graduate Institute of Nuclear Medicine, Rae Bareli Road, Lucknow, India.
| | - Mudalsha Ravina
- Sanjay Gandhi Post Graduate Institute of Nuclear Medicine, Rae Bareli Road, Lucknow, India
| | - Kasturi Rangan
- Sanjay Gandhi Post Graduate Institute of Nuclear Medicine, Rae Bareli Road, Lucknow, India
| | - Manish Dixit
- Sanjay Gandhi Post Graduate Institute of Nuclear Medicine, Rae Bareli Road, Lucknow, India
| | - Sukanta Barai
- Sanjay Gandhi Post Graduate Institute of Nuclear Medicine, Rae Bareli Road, Lucknow, India
| | - Jamshed Bomanji
- Department of Nuclear Medicine, of Nuclear Medicine, UCLH NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK.
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Epidemiologic and Demographic Attributes of Primary Spondylodiscitis in a Middle Eastern Population Sample. World Neurosurg 2016; 95:31-39. [DOI: 10.1016/j.wneu.2016.07.088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/22/2016] [Accepted: 07/23/2016] [Indexed: 12/17/2022]
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65
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Kim CJ, Kim EJ, Song KH, Choe PG, Park WB, Bang JH, Kim ES, Park SW, Kim HB, Oh MD, Kim NJ. Comparison of characteristics of culture-negative pyogenic spondylitis and tuberculous spondylitis: a retrospective study. BMC Infect Dis 2016; 16:560. [PMID: 27733126 PMCID: PMC5060001 DOI: 10.1186/s12879-016-1897-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 10/05/2016] [Indexed: 12/14/2022] Open
Abstract
Background Differences between the characteristics of culture positive pyogenic spondylitis (CPPS) and tuberculous spondylitis (TS) are well known. However, differences between the characteristics of culture negative pyogenic spondylitis (CNPS) and TS have not been reported; these would be more helpful in clinical practice especially when initial microbiologic examination of blood and/or biopsy tissue did not reveal the causative bacteria in patients with infectious spondylitis. Methods We performed a retrospective review of the medical records of patients with CNPS and TS. We compared the characteristics of 71 patients with CNPS with those of 94 patients with TS. Results Patients with TS had more previous histories of tuberculosis (9.9 vs 22.3 %, p = 0.034), simultaneous tuberculosis other than of the spine (0 vs 47.9 %, p < 0.001), and positive results in the interferon-gamma release assay (27.6 vs 79.2 %, p < 0.001). Fever (15.5 vs. 31.8 %, p = 0.018), psoas abscesses (15.5 vs 33.0 %, p = 0.011), and paravertebral abscesses (49.3 vs. 74.5 %, p = 0.011) were also more prevalent in TS than CNPS. Conclusions Different from or contrary to the previous comparisons between CPPS and TS, fever, psoas abscesses, and paravertebral abscesses are more common in patients with TS than in those with CNPS.
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Affiliation(s)
- Chung-Jong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 110-744, Republic of Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Eun Jung Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 110-744, Republic of Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 110-744, Republic of Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sang Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Hong-Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 110-744, Republic of Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 110-744, Republic of Korea.
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Yu SH, Kim DH, Kim HS, Nam KH, Choi BK, Han IH. Infectious Spondylodiscitis by Uncommon Pathogens: A Pitfall of Empirical Antibiotics. KOREAN JOURNAL OF SPINE 2016; 13:97-101. [PMID: 27799986 PMCID: PMC5086476 DOI: 10.14245/kjs.2016.13.3.97] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/27/2016] [Accepted: 07/29/2016] [Indexed: 12/18/2022]
Abstract
Objective The goal of this study is to evaluate the prevalence of spondylodiscitis (SD) caused by uncommon pathogens and review the efficacy of the treatment strategy including the coverage by usual empirical broad-spectrum antibiotic therapy. Methods Ninety-nine consecutive patients diagnosed and treated for infectious SD between January 2007 to May 2015 were reviewed retrospectively. The prevalence of uncommon SD, predisposing factors, antibiotics sensitivity, and clinical outcome were analyzed in comparison with that of common SD. Results Among 99 patients, 68 patients were culture positive. Out of 68 patients with positive culture results, 54 of them(79.4%) were common pathogen and 14 (20.6%) were uncommon pathogen. Postoperative SDs were significantly prevalent in uncommon SD(42.9%) than common SD(27.8%). Recurrence rate was higher in uncommon pathogen SD(14.3%) than common SD group (2.3%), and it showed statistically significant difference (p=0.025). Empirical antibiotics of vancomycin and 3rd or 4th generation cephalosporin covered 100% of nontuberculous common SD and 14.3% of uncommon SD. Conclusion In our study, the prevalence of uncommon SD was relatively high uncommon (20.5% of culture positive SD and 14.1% of total cases) and the coverage rate of empirical antibiotics for them were only 14.3%. In particular, the possibility of SD with fun gal, polymicrobial, or multiple drug resistant organism should be considered in SD unresponsive to broad spectrum antibiotics therapy.
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Affiliation(s)
- Seung Han Yu
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University College of Medicine, Busan, Korea
| | - Dong Hwan Kim
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University College of Medicine, Busan, Korea
| | - Hwan Soo Kim
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University College of Medicine, Busan, Korea
| | - Kyoung Hyup Nam
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University College of Medicine, Busan, Korea
| | - Byung Kwan Choi
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University College of Medicine, Busan, Korea
| | - In Ho Han
- Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University College of Medicine, Busan, Korea
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Farooq Z, Devenney-Cakir B. Clinical case report: discitis osteomyelitis complicated by inferior vena cava venous thrombosis and septic pulmonary emboli. Radiol Case Rep 2016; 11:370-374. [PMID: 27920864 PMCID: PMC5128360 DOI: 10.1016/j.radcr.2016.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/12/2016] [Indexed: 12/17/2022] Open
Abstract
Viridans group streptococcus is an infrequent cause of osteomyelitis that is found in association with infective endocarditis. Only a few studies report viridans osteomyelitis in the absence of endocarditis. Vertebral pyogenic osteomyelitis can sometimes be complicated by psoas or paraspinal abscesses. These intra-abdominal and/or pelvic collections can very rarely result in venous thrombosis. A paraspinal abscess resulting in inferior vena cava (IVC) thrombosis has only been reported once in the literature. We report a case of a young female with a history of polysubstance abuse and chronic back pain, who was found to have extensive vertebral osteomyelitis and discitis with epidural, paraspinal, and psoas abscesses caused by viridans streptococci. These abscesses compressed on the IVC causing IVC thrombophlebitis extending to the iliac veins distally. Imaging also demonstrated multifocal bilateral septic pulmonary emboli and pleural effusions secondary to septic IVC thrombus; a transesophageal echocardiogram showed no evidence of infective endocarditis.
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Affiliation(s)
- Zerwa Farooq
- Department of Radiology, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA
| | - Brooke Devenney-Cakir
- Department of Radiology, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA
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Sundaram VK, Doshi A. Infections of the spine: A review of clinical and imaging findings. APPLIED RADIOLOGY 2016. [DOI: 10.37549/ar2301] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Impact on Neurological Recovery of Transforaminal Debridement and Interbody Fusion versus Transpedicular Decompression in Combination with Pedicle Screw Instrumentation for Treating Thoracic and Lumbar Spinal Tuberculosis. Asian Spine J 2016; 10:543-52. [PMID: 27340536 PMCID: PMC4917775 DOI: 10.4184/asj.2016.10.3.543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/09/2015] [Accepted: 11/14/2015] [Indexed: 12/19/2022] Open
Abstract
Study Design Retrospective study. Purpose To compare the neurological outcome of transforaminal debridement and interbody fusion with transpedicular decompression for treatment of thoracic and lumbar spinal tuberculosis. Overview of Literature Few articles have addressed the impact of neurological recovery in patients with tuberculosis who were treated by two different operative methods via the posterior-only approach. Methods Clinical and radiographic results of one-stage posterior instrumented spinal fusion for treatment of tuberculous spondylodiscitis with neurological deficits were reviewed and analyzed from 2009 to 2013. The extensive (E) group consisted of patients who received transforaminal debridement and interbody fusion, whereas transpedicular decompression was performed on limited (L) group. Rapid recovery was improvement of at least one Frankel grade within 6 weeks after operation. Otherwise, it was slow recovery. Results All 39 patients had improved neurological signs. The median follow-up period was 24 months. Proportionately younger patients (under 65 years of age) received extensive surgery (15 of 18, 83.3% vs. 11 of 21, 52.4%; p=0.04). The mean operative time and blood loss in the group E were higher than in the group L (both p<0.01). With regard to type of procedure, especially at thoracic and thoracolumbar spine, patients who underwent extensive surgery had rapid neurological recovery significantly different from those of limited surgery (p=0.01; Relative Risk, 3.06; 95% Confidence Interval, 1.13 to 8.29). Conclusions Transforaminal debridement and interbody fusion provides more rapid neurological recovery in patients with thoracic and thoracolumbar spinal tuberculosis compared to transpedicular decompression.
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Mitić R, Stojanović N, Kostić A, Cvetković I, Dželebdžić Z. ANTERIOR AND POSTERIOR FUSION OF CERVICAL SPINE IN OSTEOMYELITIC PROCESS OF SEVERAL VERTEBRAL BODIES: A CASE REPORT. ACTA MEDICA MEDIANAE 2016. [DOI: 10.5633/amm.2016.0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Raut AA, Naphade PS, Ramakantan R. Imaging Spectrum of Extrathoracic Tuberculosis. Radiol Clin North Am 2016; 54:475-501. [DOI: 10.1016/j.rcl.2015.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Haghighatkhah H, Jafroodi Y, Sanei Taheri M, Pourghorban R, Sadeghian Dehkordy A. Multifocal Skeletal Tuberculosis Mimicking Langerhans Cell Histiocytosis in a Child: a Case Report With a Long-Term Follow-Up. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e19942. [PMID: 26744631 PMCID: PMC4700812 DOI: 10.5812/ircmj.19942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 02/03/2015] [Accepted: 03/20/2015] [Indexed: 12/19/2022]
Abstract
Introduction: Multifocal skeletal tuberculosis is a rare condition that may masquerade as Langerhans cell histiocytosis, especially in children. Case Presentation: We report a case of multifocal osseous tuberculosis in a 5-year-old female patient admitted to our hospital with a complaint of low back pain but no history of respiratory symptoms or malaise. Radiological findings included vertebra plana and multiple lytic lesions in both the frontal and pelvic bones. An initial diagnosis of Langerhans cell histiocytosis was made based on imaging findings; however, the patient underwent further evaluation for Mycobacterium tuberculosis, and histopathologic findings confirmed the diagnosis of tuberculosis. The patient showed a nearly complete response after receiving a course of anti-tuberculosis drugs. Conclusions: A high index of suspicion is required for the early diagnosis and prompt treatment of patients with osseous tuberculosis. Given the high prevalence of tuberculosis in developing countries, tuberculosis should be considered in the differential diagnosis of multifocal lytic lesions and vertebra plana, especially in children.
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Affiliation(s)
- Hamidreza Haghighatkhah
- Department of Radiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Yousef Jafroodi
- Department of Pediatrics, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Morteza Sanei Taheri
- Department of Radiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Ramin Pourghorban
- Department of Radiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Afarin Sadeghian Dehkordy
- Department of Radiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Role of Magnetic Resonance Imaging in Differentiating Spondylitis from Vertebral Metastasis. Asian Spine J 2015; 9:776-82. [PMID: 26435798 PMCID: PMC4591451 DOI: 10.4184/asj.2015.9.5.776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/25/2015] [Accepted: 02/27/2015] [Indexed: 12/19/2022] Open
Abstract
Study Design Observational analytic design with a cross-sectional approach. Purpose To analyze the suitability of magnetic resonance imaging (MRI) in distinguishing radiology images with a corresponding delineation of spondylitis and vertebral metastasis confirmed by histology results. Overview of Literature MRI is an accurate modality for assessing vertebrae and their disorders. Infections and metastasis are most commonly found in the vertebrae. It is difficult to differentiate between these two disorders both clinically and radiographically, particularly in atypical cases. Methods McNemar statistical test was used to analyze the data. Samples were chosen using the consecutive method. There were 35 samples (14 males and 21 females), consisting of 22 samples of spondylitis and 13 samples of metastasis confirmed on histology examination. Results Nineteen (86%) out of the 22 samples of histological spondylitis were diagnosed as having spondylitis on MRI, whereas all 13 samples of metastasis were 100% accurately diagnosed on MRI. Conclusions There was no statistically significant difference between diagnostic radiology using MRI and histological diagnosis with a p=0.250 (p>0.05). In this respect, MRI was more precise in diagnosing metastasis. Typical MRI description of spondylitis was the involvement of anterior vertebrae and components of intervertebral discs, stiffening of discs, paravertebral abscess, and involvement of the vertebral segment sequence. Typical MRI delineation of metastasis was involvement of the anterior posterior vertebral component, paravertebral mass, and skip lesions.
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Yoon YK, Jo YM, Kwon HH, Yoon HJ, Lee EJ, Park SY, Park SY, Choo EJ, Ryu SY, Lee MS, Yang KS, Kim SW. Differential diagnosis between tuberculous spondylodiscitis and pyogenic spontaneous spondylodiscitis: a multicenter descriptive and comparative study. Spine J 2015; 15:1764-71. [PMID: 25862505 DOI: 10.1016/j.spinee.2015.04.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 03/09/2015] [Accepted: 04/02/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although tuberculous and pyogenic spondylodiscitis are common causes of spinal infections, their protean manifestation complicates differential diagnosis. PURPOSE The clinical, laboratory, and radiologic characteristics of tuberculous and pyogenic spontaneous spondylodiscitis were compared in this study. STUDY DESIGN This multicenter retrospective study was conducted in 11 teaching hospitals in the Republic of Korea from January 2011 to December 2013. PATIENT SAMPLE Study subjects included adult patients (≥18 years) diagnosed with tuberculous (n=60) or pyogenic (n=117) spontaneous spondylodiscitis. OUTCOME MEASURES Risk factors for tuberculous spondylodiscitis were determined, and their predictive performance was evaluated. METHODS Multivariate logistic regression analysis was performed to determine predictors independently associated with tuberculous spondylodiscitis. Receiver-operating characteristic curve analysis using the presence or absence of risk factors was used to generate a risk index to identify patients with increased probability of tuberculous spondylodiscitis. RESULTS Of 177 patients, multivariate logistic regression analysis showed that patients with tuberculous spondylodiscitis (n=60) were more frequently women, with increased nonlumbar spinal involvement and associated non-spinal lesions, delayed diagnosis, higher serum albumin levels, reduced white blood cell counts, and lower C-reactive protein and procalcitonin levels. Among 117 patients with pyogenic spondylodiscitis, the most frequent causative microorganism was Staphylococcus aureus (64.1%). The mean diagnostic delay was significantly shorter, which may reflect higher clinical expression leading to earlier diagnosis. A combination of clinical data and biomarkers had better predictive value for differential diagnosis compared with biomarkers alone, with an area under the curve of 0.93, and sensitivity, specificity, and positive and negative predictive values of 95.0%, 79.5%, 70.4%, and 96.9%, respectively. CONCLUSIONS This study provides guidance for clinicians to predict the causative organisms of spondylodiscitis in uncertain situations and before culture or pathologic examinations. Clinical data and single biomarkers combined can be useful for differential diagnoses between tuberculous and pyogenic spondylodiscitis.
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Affiliation(s)
- Young K Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Anam Hospital, 3 Inchon-ro, Seongbuk-gu, Seoul 136-705, Republic of Korea
| | - Yu M Jo
- Division of Infectious Diseases, Department of Internal Medicine, Konyang University Hospital, 685 Gasuwon-dong seo-gu, Metropolitan city Daejon 302-718 Republic of Korea
| | - Hyun H Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Daegu Catholic University Medical Center, 33 Duryungwon-ro Nam-gu, Daegu 705-718 Republic of Korea
| | - Hee J Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Daejeon Hospital, 68 Hanglbisuk-ro, Nowon-gu, Seoul 139-872 Republic of Korea
| | - Eun J Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, 59 Daesangwan-ro, Yongsan-gu, Seoul 140-887 Republic of Korea
| | - So Y Park
- Division of Infectious Diseases, Department of Internal Medicine, Kangdong Sacred Heart Hospital, 55, Beodeunaru-ro, Yeongdeungpo-gu, Seoul 150-037 Republic of Korea
| | - Seong Y Park
- Division of Infectious Diseases, Department of Internal Medicine, Dongguk University Ilsan Hospital, 27 Dongguk-ro Ilsandong-gu, Goyang-si, Gyeonggi-do 410-773 Republic of Korea
| | - Eun J Choo
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, 170 jonaru-ro Wonmi-gu Bucheon city, Gyenggi-do 420-767 Republic of Korea
| | - Seong Y Ryu
- Division of Infectious Diseases, Department of Internal Medicine, Keimyung University Dongsan Hospital, 56 Dalseong-Ro, Jung-Gu, Daegu 700-712 Republic of Korea
| | - Mi S Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Medical Center, 23 Kyungheedae-ro Dongdaemun-gu Seoul 130-872, Republic of Korea
| | - Kyung S Yang
- Department of Biostatistics, Korea University College of Medicine, 73 Inchon-ro, Seoul, Seoul 136-705, Republic of Korea
| | - Shin W Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, 130 Dongdoek-ro Jung-gu, Daegu 700-721, Republic of Korea.
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Mavrogenis AF, Igoumenou V, Tsiavos K, Megaloikonomos P, Panagopoulos GN, Vottis C, Giannitsioti E, Papadopoulos A, Soultanis KC. When and how to operate on spondylodiscitis: a report of 13 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 26:31-40. [PMID: 26190644 DOI: 10.1007/s00590-015-1674-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 07/13/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE Conflicting reports exist regarding the surgical indications, timing, approach, staged or not operation, and spinal instrumentation for patients with spondylodiscitis. Therefore, we performed this study to evaluate the outcome of a series of patients with spondylodiscitis aiming to answer when and how to operate on these patients. MATERIALS AND METHODS We retrospectively studied the files of 153 patients with spondylodiscitis treated at our institution from 2002 to 2012. The approach included MR imaging of the infected spine, isolation of the pathogen with blood cultures and/or biopsy, and further conservative or surgical treatment. The mean follow-up was 6 years (range 1-13 years). We evaluated the indications, timing (when), and methods (how) for surgical treatment, and the clinical outcome of these patients. RESULTS Orthopedic surgical treatment was necessary for 13 of the 153 patients (8.5 %). These were patients with low access to healthcare systems because of low socioeconomic status, third-country migrants, prisoners or intravenous drug use, patients in whom a bacterial isolate documentation was necessary, and patients with previous spinal operations. The most common pathogen was Mycobacterium tuberculosis. The surgical indications included deterioration of the neurological status (11 patients), need for bacterial isolate (10 patients), septicemia due to no response to antibiotics (five patients), and/or spinal instability (three patients). An anterior vertebral approach was more commonly used. Nine of the 13 patients had spinal instrumentation in the same setting. Improvement or recovery of the neurological status was observed postoperatively in all patients with preoperative neurological deficits. Postoperatively, two patients deceased from pulmonary infection and septicemia, and heart infarction. At the last follow-up, patients who were alive were asymptomatic; ten patients were neurologically intact, and one patient experienced paraparesis. Imaging showed spinal fusion, without evidence of recurrent spondylodiscitis. Complications related to the spinal instrumentation were not observed in the respective patients. CONCLUSIONS Conservative treatment is the standard for spondylodiscitis. Physicians should be alert for Mycobacterium tuberculosis spondylitis because of the low access to healthcare systems of patients with low social and economic status. Surgical indications include obtaining tissue sample for diagnosis, occurrence or progression of neurological symptoms, failure of conservative treatment, large anterior abscesses, and very extensive disease. Thorough debridement of infected tissue and spinal stability is paramount. The anterior approach provides direct access and improved exposure to the most commonly affected part of the spine. Spinal instrumentation is generally recommended for optimum spinal stability and fusion, without any implant-related complications.
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Affiliation(s)
- Andreas F Mavrogenis
- First Department of Orthopaedics, ATTIKON University General Hospital, Athens University Medical School, 41 Ventouri Street, 15562, Holargos, Athens, Greece.
| | - Vasilis Igoumenou
- First Department of Orthopaedics, ATTIKON University General Hospital, Athens University Medical School, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Konstantinos Tsiavos
- First Department of Orthopaedics, ATTIKON University General Hospital, Athens University Medical School, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Panayiotis Megaloikonomos
- First Department of Orthopaedics, ATTIKON University General Hospital, Athens University Medical School, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Georgios N Panagopoulos
- First Department of Orthopaedics, ATTIKON University General Hospital, Athens University Medical School, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Christos Vottis
- First Department of Orthopaedics, ATTIKON University General Hospital, Athens University Medical School, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Efthymia Giannitsioti
- Fourth Department of Internal Medicine, ATTIKON University General Hospital, Athens University Medical School, Athens, Greece
| | - Antonios Papadopoulos
- Fourth Department of Internal Medicine, ATTIKON University General Hospital, Athens University Medical School, Athens, Greece
| | - Konstantinos C Soultanis
- First Department of Orthopaedics, ATTIKON University General Hospital, Athens University Medical School, 41 Ventouri Street, 15562, Holargos, Athens, Greece
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Raya Cruz M, Vilchez Rueda H, Marinescu C, Sarasíbar Ezcurra H, Riera Jaume M, Payeras Cifre A. Infectious spondylitis in the Balearic Islands: An analysis of 51 cases. Rev Clin Esp 2015. [DOI: 10.1016/j.rceng.2015.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Raya Cruz M, Vilchez Rueda H, Marinescu C, Sarasíbar Ezcurra H, Riera Jaume M, Payeras Cifre A. Espondilitis infecciosa en Baleares: análisis de 51 casos. Rev Clin Esp 2015; 215:251-7. [DOI: 10.1016/j.rce.2015.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/31/2014] [Accepted: 01/20/2015] [Indexed: 12/17/2022]
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