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Winkler WL, George IA, Gandra S, Baker JC, Tomasian A, Northrup B, Velde TLV, Hillen TJ, Luo C, Imaoka R, Dettorre GM, Jennings JW. Diagnostic efficacy and clinical impact of image-guided core needle biopsy of suspected vertebral osteomyelitis. Int J Infect Dis 2024; 144:107027. [PMID: 38670483 DOI: 10.1016/j.ijid.2024.107027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/17/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES The diagnostic yield and clinical impact of image-guided core needle biopsy (ICNB) of suspected vertebral osteomyelitis in adults is heterogenous in published studies owing to small sample sizes, indicating the need for large cohort studies. METHODS A retrospective analysis of ICNBs was performed from 2010 to 2021 for patients with imaging findings consistent with vertebral osteomyelitis. For each biopsy, a series of factors were analyzed, as well as if histopathology was diagnostic of osteomyelitis and if microbiological cultures were positive. In addition, it was recorded in what way biopsy influenced clinical management regarding antimicrobial treatment. A multivariate statistical analysis was performed to evaluate the factors associated with yield. RESULTS A total of 570 biopsies performed on 527 patients were included. A histopathologic diagnosis of osteomyelitis was made in 68.4% (359 of 525) of biopsies, and microbiological cultures were positive in 29.6% (169 of 570). Elevated erythrocyte sedimentation rate was positively associated with a histopathologic diagnosis of osteomyelitis (odds ratio [OR] =1.96, P = 0.007) and positive cultures from bone cores (OR = 1.02, P ≤0.001) and aspirate (OR = 1.02, P ≤0.001). Increased total core length was positively associated with a histopathologic diagnosis of osteomyelitis (OR = 1.81, P = 0.013) and positive cultures from bone cores (OR = 1.65, P = 0.049). Clinical management was affected by ICNB in 37.5% (214 of 570) of cases. CONCLUSIONS In this large cohort, ICNB yielded approximately 30% positive cultures and changed clinical management in over one-third of the patients.
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Affiliation(s)
- Winston L Winkler
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, St. Louis, USA.
| | - Ige A George
- John T. Milliken Department of Internal Medicine, Division of Infectious Disease, St. Louis, USA
| | - Sumanth Gandra
- John T. Milliken Department of Internal Medicine, Division of Infectious Disease, St. Louis, USA
| | - Jonathan C Baker
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, St. Louis, USA
| | - Anderanik Tomasian
- Department of Radiology, Section of Musculoskeletal Radiology, University of Southern California, Los Angeles, USA
| | - Benjamin Northrup
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, St. Louis, USA
| | - Theodore L Vander Velde
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, St. Louis, USA
| | - Travis J Hillen
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, St. Louis, USA
| | - Chongliang Luo
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Resten Imaoka
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, St. Louis, USA
| | - Gino M Dettorre
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, St. Louis, USA
| | - Jack W Jennings
- Department of Radiology, Section of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, St. Louis, USA
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Dayer R, De Marco G, Vazquez O, Tabard-Fougère A, Cochard B, Gavira N, Di Laura Frattura G, Guanziroli Pralong N, Steiger C, Ceroni D. Laboratory diagnostics for primary spinal infections in pediatric and adult populations: a narrative review. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100270. [PMID: 37767011 PMCID: PMC10520565 DOI: 10.1016/j.xnsj.2023.100270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023]
Abstract
Primary spinal infection (PSI) is a generic term covering a heterogeneous group of infections that can affect the vertebral body, intervertebral disks, the content of the medullary cavity, and adjacent paraspinal tissues. Patients' characteristics can vary significantly, notably according to their age, and some of these characteristics undoubtedly play a primordial role in the occurrence of a PSI and in the type of offending pathogen. Before approaching the subject of laboratory diagnostics, it is essential to define the characteristics of the patient and their infection, which can then guide the physician toward specific diagnostic approaches. This review critically examined the roles and usefulness of traditional and modern laboratory diagnostics in supporting clinicians' decision-making in cases of pediatric and adult primary spinal infection (PSI). It appears impossible to compare PSIs in children and adults, whether from an epidemiological, clinical, bacteriological, or biological perspective. The recipients are really too different, and the responsible germs are closely correlated to their age. Secondly, the interpretation of traditional laboratory blood tests appears to contribute little guidance for clinicians attempting to diagnose a PSI. Biopsy or needle aspiration for bacterial identification remains a controversial subject, as the success rates of these procedures for identifying causative organisms are relatively uncertain in pediatric populations.Using nucleic acid amplification assays (NAAAs) on biopsy samples has been demonstrated to be more sensitive than conventional cultures for diagnosing PSI. Recent advances in next-generation sequencing (NGS) are particularly interesting for establishing a microbiological diagnosis of a PSI when standard cultures and NAAAs have failed to detect the culprit. We can even imagine that plasma metagenomic NGS using plasma (known as "liquid biopsy") is a diagnostic approach that can detect not only pathogens circulating in the bloodstream but also those causing focal infections, and thus eliminate the need for source sample collection using costly invasive surgical procedures.
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Affiliation(s)
- Romain Dayer
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Giacomo De Marco
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Oscar Vazquez
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Anne Tabard-Fougère
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Blaise Cochard
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Nathaly Gavira
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Giorgio Di Laura Frattura
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Nastassia Guanziroli Pralong
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Christina Steiger
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Dimitri Ceroni
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
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3
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Parker MFL, López-Álvarez M, Alanizi AA, Luu JM, Polvoy I, Sorlin AM, Qin H, Lee S, Rabbitt SJ, Pichardo-González PA, Ordonez AA, Blecha J, Rosenberg OS, Flavell RR, Engel J, Jain SK, Ohliger MA, Wilson DM. Evaluating the Performance of Pathogen-Targeted Positron Emission Tomography Radiotracers in a Rat Model of Vertebral Discitis-Osteomyelitis. J Infect Dis 2023; 228:S281-S290. [PMID: 37788505 PMCID: PMC11009497 DOI: 10.1093/infdis/jiad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Vertebral discitis-osteomyelitis (VDO) is a devastating infection of the spine that is challenging to distinguish from noninfectious mimics using computed tomography and magnetic resonance imaging. We and others have developed novel metabolism-targeted positron emission tomography (PET) radiotracers for detecting living Staphylococcus aureus and other bacteria in vivo, but their head-to-head performance in a well-validated VDO animal model has not been reported. METHODS We compared the performance of several PET radiotracers in a rat model of VDO. [11C]PABA and [18F]FDS were assessed for their ability to distinguish S aureus, the most common non-tuberculous pathogen VDO, from Escherichia coli. RESULTS In the rat S aureus VDO model, [11C]PABA could detect as few as 103 bacteria and exhibited the highest signal-to-background ratio, with a 20-fold increased signal in VDO compared to uninfected tissues. In a proof-of-concept experiment, detection of bacterial infection and discrimination between S aureus and E coli was possible using a combination of [11C]PABA and [18F]FDS. CONCLUSIONS Our work reveals that several bacteria-targeted PET radiotracers had sufficient signal to background in a rat model of S aureus VDO to be potentially clinically useful. [11C]PABA was the most promising tracer investigated and warrants further investigation in human VDO.
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Affiliation(s)
- Matthew F L Parker
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, New York
| | - Marina López-Álvarez
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Aryn A Alanizi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Justin M Luu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Ilona Polvoy
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Alexandre M Sorlin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Hecong Qin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Sanghee Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Sarah J Rabbitt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | | | - Alvaro A Ordonez
- Center for Infection and Inflammation Imaging Research, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph Blecha
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | | | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Joanne Engel
- Department of Medicine, University of California, San Francisco
- UCSF Department of Microbiology and Immunology, San Francisco, California
| | - Sanjay K Jain
- Center for Infection and Inflammation Imaging Research, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - David M Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
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4
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Lacasse M, Derolez S, Bonnet E, Amelot A, Bouyer B, Carlier R, Coiffier G, Cottier JP, Dinh A, Maldonado I, Paycha F, Ziza JM, Bemer P, Bernard L. 2022 SPILF - Clinical Practice guidelines for the diagnosis and treatment of disco-vertebral infection in adults. Infect Dis Now 2023; 53:104647. [PMID: 36690329 DOI: 10.1016/j.idnow.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/12/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
These guidelines are an update of those made in 2007 at the request of the French Society of Infectious Diseases (SPILF, Société de Pathologie Infectieuse de Langue Française). They are intended for use by all healthcare professionals caring for patients with disco-vertebral infection (DVI) on spine, whether native or instrumented. They include evidence and opinion-based recommendations for the diagnosis and management of patients with DVI. ESR, PCT and scintigraphy, antibiotic therapy without microorganism identification (except for emergency situations), therapy longer than 6 weeks if the DVI is not complicated, contraindication for spinal osteosynthesis in a septic context, and prolonged dorsal decubitus are no longer to be done in DVI management. MRI study must include exploration of the entire spine with at least 2 orthogonal planes for the affected level(s). Several disco-vertebral samples must be performed if blood cultures are negative. Short, adapted treatment and directly oral antibiotherapy or early switch from intravenous to oral antibiotherapy are recommended. Consultation of a spine specialist should be requested to evaluate spinal stability. Early lifting of patients is recommended.
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Affiliation(s)
- M Lacasse
- Medecine Interne et Maladies Infectieuses, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - S Derolez
- Rhumatologie, 125 rue de Stalingrad, CHU Avicenne, 93000 Bobigny, France
| | - E Bonnet
- Maladies Infectieuses, Pl. Dr Baylac, CHU Purpan, 31000 Toulouse, France.
| | - A Amelot
- Neurochirurgie, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - B Bouyer
- Chirurgie orthopédique et traumatologique, CHU de Bordeaux, Place Amélie Raba-léon, 33076 Bordeaux, France
| | - R Carlier
- Imagerie, Hôpital Raymond Poincaré, 104 Bd R Poincaré, 92380 Garches, France
| | - G Coiffier
- Rhumatologie, GH Rance-Emeraude, Hôpital de Dinan, 22100 Dinan, France
| | - J P Cottier
- Radiologie, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - A Dinh
- Maladies Infecteiuses, CHU Raymond Poicaré, 92380 Garches, France
| | - I Maldonado
- Radiologie, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - F Paycha
- Médecine Nucléaire, Hôpital Lariboisière, 2 rue Ambroise Paré 75010 Paris, France
| | - J M Ziza
- Rhumatologie et Médecine Interne. GH Diaconesses Croix Saint Simon, 75020 Paris, France
| | - P Bemer
- Microbiologie, CHU de Nantes, 1 Place A. Ricordeau, Nantes 44000 Cedex 1, France
| | - L Bernard
- Medecine Interne et Maladies Infectieuses, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
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5
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Chang CY, Pelzl C, Jesse MK, Habibollahi S, Habib U, Gyftopoulos S. Image-Guided Biopsy in Acute Diskitis-Osteomyelitis: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2023; 220:499-511. [PMID: 36222488 DOI: 10.2214/ajr.22.28423] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND. The reported sensitivity and yield of image-guided biopsies for diskitis-osteomyelitis vary widely. OBJECTIVE. The purpose of this study was to perform a systematic review of the literature and meta-analysis of pooled sensitivity data to elucidate strategies for optimal image-guided biopsies among patients suspected to have diskitis-osteomyelitis. EVIDENCE ACQUISITION. A comprehensive literature search was performed for studies of patient populations with proven or suspected diskitis-osteomyelitis that included percutaneous image-guided biopsy as part of the workup algorithm. Type of pathogens, imaging modality used for biopsy guidance, tissue targeted, antibiotic administration at the time of biopsy, true microbiology positives, true microbiology negatives, false microbiology positives, false microbiology negatives, disease (i.e., diskitis-osteomyelitis) positives as determined by reference standard, true infection positives (i.e., positive microbiology or pathology results), and total number of biopsies performed were extracted from the studies. Microbiology sensitivity, microbiology biopsy yield, and infection sensitivity were calculated from the pooled data. These terms and the data required to calculate them were also defined in detail. EVIDENCE SYNTHESIS. Thirty-six articles satisfied inclusion criteria and were used for analysis. The pooled microbiology sensitivity, infection sensitivity, and microbiology biopsy yields were 46.6%, 70.0%, and 26.7%, respectively. Mycobacterium tuberculosis-only microbiology sensitivity was significantly higher than both pyogenic bacteria and mixed-organism microbiology sensitivity (p < .001). Staphylococcus aureus was the most common causative organism (28.6%). Pooled microbiology sensitivity was not significantly different for CT guidance and fluoroscopy guidance (p = .16). There was a statistically significant difference between pooled microbiology sensitivity of bone/end plate (45.5%) and disk/paravertebral soft-tissue (64.8%) image-guided biopsies (p < .001). There was no statistically significant difference in pooled microbiology sensitivities for patients who received antibiotics before the procedure (46.2%) and those who did not (44.6%) (p = .70). CONCLUSION. Image guidance by CT or fluoroscopy does not affect microbiology yield, disk and paravertebral soft-tissue biopsies should be considered over bone and end plate biopsies, and preprocedural antibiotic administration does not appear to impact biopsy results. CLINICAL IMPACT. Understanding and correctly applying reported statistics contribute to appropriate interpretation of the abundant literature on this topic and optimization of care for patients with diskitis-osteomyelitis.
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Affiliation(s)
- Connie Y Chang
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 6E, Boston, MA 02114
| | - Casey Pelzl
- Harvey L. Neiman Health Policy Institute, Reston, VA
| | | | - Sina Habibollahi
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 6E, Boston, MA 02114
| | - Ukasha Habib
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 6E, Boston, MA 02114
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6
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Mazarakis NK, Baren J, Loughenbury PR, Koutsarnakis C, Gupta H, Fawcett RW. Site matters: Image-guided percutaneous sampling of intervertebral disc results in increased positive diagnostic yield in spondylodiscitis. Br J Neurosurg 2023; 37:177-181. [PMID: 34904496 DOI: 10.1080/02688697.2021.2013438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Spondylodiscitis is a common referral to spinal on call services. Identification of the causative organism is vital in order to dictate the appropriate antibiotic treatment. In this context, the surgical and interventional radiology team is often asked to perform a diagnostic biopsy. The aim of the present study was to assess whether the sampling location affects the diagnostic yield. Our results suggest that the overall positive diagnostic yield was 35%. When disc material was included in the sample the diagnostic yield significantly improved to 47%. Bone sampling alone had a positive yield of 15%. Age, pre-biopsy CRP, pre-biopsy use of antibiotics did not seem to affect the likelihood of obtaining a positive yield. These results suggests that when performing image guided biopsies for suspected cases of spondylodiscitis the inclusion of disc material is important.
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Affiliation(s)
- Nektarios K Mazarakis
- Department of Spinal Surgery, Division of Neurosciences, Leeds General Infirmary, Leeds, UK
| | - James Baren
- Department of Interventional Radiology, Leeds General Infirmary, Leeds, UK
| | - Peter R Loughenbury
- Department of Spinal Surgery, Division of Neurosciences, Leeds General Infirmary, Leeds, UK
| | | | - Harun Gupta
- Department of Interventional Radiology, Leeds General Infirmary, Leeds, UK
| | - Richard W Fawcett
- Department of Interventional Radiology, Leeds General Infirmary, Leeds, UK
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7
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Mirbagheri A, Etminan N, Schölch S, Maier C, Perrin J, Enders F. Lumbar Spondylodiscitis Mimicking Cholecystitis: A Case Report and Review of Literature. J Neurol Surg A Cent Eur Neurosurg 2023; 84:95-102. [PMID: 35354214 DOI: 10.1055/a-1811-7393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Lower back pain is a frequent cause of emergency department visits and one of the leading causes of the disease burden worldwide. The purpose of this case report and literature review was to discuss atypical abdominal entities mimicking spinal diseases typically presenting with lower back pain. METHODS A 79-year-old man presented with lower back pain and urinary incontinence after receiving a non-image-guided lumbar infiltration treatment 4 weeks prior to admission. The magnetic resonance imaging (MRI) highlighted multisegmental hyperintensities in the intervertebral disk spaces of the lumbar spine indicative for spondylodiscitis. Antibiotic treatment over a week did not lead to significant clinical improvement. Blood cultures, cardiologic, otorhinolaryngologic, and dental examinations turned out negative for a focus of infection. A computed tomography (CT) guided biopsy was indicated after discontinuation of antibiotic treatment for less than 24 hours. Rapid clinical deterioration with concomitant onset of abdominal pain resulted in the diagnosis of cholecystitis, which required cholecystectomy. We performed a systematic literature review using the Pubmed database for the keywords "spondylodiscitis," "spine," "abdominal," and "cholecystitis," to identify abdominal diseases that mimic spine pathologies and spinal diseases that mimic abdominal pathologies. RESULTS No other report in English literature of cholecystitis associated with initial onset of lower back pain was identified. Eighteen reports referred to abdominal conditions that mimic spinal diseases, among them a patient with cyclic lumbar back pain who received a lumbar spinal fusion who, after persisting symptoms led to further diagnostic procedures, was ultimately diagnosed with endometriosis. Spinal symptoms included paraplegia and urinary incontinence as results of acute aortic pathologies. Eleven reports presented spinal pain mimicking abdominal conditions including abdominal pain and diarrhea as well as have had surgical procedures such as an appendectomy before the spinal condition was discovered. CONCLUSION Clinical symptoms of the spine such as lower back pain can be unspecific and lead to false conclusions in the presence of concomitant pathologies in MRI. Only clinical deterioration in our case patient prompted correction of the diagnosis on day 7. Initial workup for alternative common infectious foci such as lung and urinary tract was performed, but further abdominal workup despite the absence of abdominal symptoms may have led to an earlier diagnosis. Our literature review found several cases of misdiagnosed spinal and abdominal conditions. Some had undergone unnecessary surgical procedures before the right diagnosis was made. Because of the high incidence of symptoms such as lumbar back pain and abdominal pain, considering optimal patient care as well as economic aspects, it would be essential to conduct an interdisciplinary clinical management to avoid errors in the early stage of diagnostics.
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Affiliation(s)
- Andia Mirbagheri
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nima Etminan
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sebastian Schölch
- Junior Clinical Cooperation Unit Translational Surgical Oncology (A430), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Surgery, University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christopher Maier
- Junior Clinical Cooperation Unit Translational Surgical Oncology (A430), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Surgery, University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jason Perrin
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frederik Enders
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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8
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[Translated article] Analysis of results of open and percutaneous disc biopsy in the diagnosis of spondylodiscitis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022. [DOI: 10.1016/j.recot.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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9
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Navarro-Navarro R, Suárez-Cabañas A, Fernández-Varela T, Lorenzo-Rivero J, Montesdeoca-Ara A. Análisis de los resultados de la biopsia discal abierta y percutánea en el diagnóstico de la espondilodiscitis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:189-199. [DOI: 10.1016/j.recot.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/20/2021] [Accepted: 09/24/2021] [Indexed: 12/01/2022] Open
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10
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Pazinato LV, Urakawa FS, Setuguti DT, da Motta-Leal-Filho JM, de Menezes MR. Diagnostic Yield of Computed Tomography-Guided Procedures for Spondylodiscitis. Cardiovasc Intervent Radiol 2022; 45:800-807. [PMID: 35391545 DOI: 10.1007/s00270-022-03132-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/21/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To identify the diagnostic yield and predictive factors for microbiological diagnosis in patients with spondylodiscitis through computed tomography (CT)-guided biopsy or aspiration. MATERIALS AND METHODS A retrospective review of 102 patients with suspected spondylodiscitis who underwent CT-guided procedures in an 8-year period was conducted. Analyzed variables were demographic data, C-reactive protein, pre-biopsy MRI findings, prior antibiotic use, site of biopsy/aspiration, histopathological findings, culture results and radiation dose. RESULTS The culture yield among all sites was 56%, 85.6% for paravertebral/discal fluid aspiration, 66.7% for disk-only biopsy, 52.9% for paravertebral soft tissue biopsy, and 39.6% for endplate bone-disk unit. Patients with paravertebral/disk collection on MRI had better yields when submitted to fluid aspiration instead of biopsy of other sites (78.9% vs. 36.6%; p = 0,006). Pyogenic etiology corresponded to 68.3% of cases and Staphylococcus aureus was the most common agent. Prior antibiotics exposure was associated with a lower yield (66.2% vs. 40.9%, p = 0,016). CONCLUSIONS CT-guided procedures are safe and well-tolerated in patients with suspected spondylodiscitis, with good microbiologic yield particularly in the presence of paravertebral/discal abscess.
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Affiliation(s)
- Lucas Vatanabe Pazinato
- Interventional Radiology, Department of Radiology, University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, Sao Paulo, SP, 05403-000, Brazil.
| | - Felipe Shoiti Urakawa
- Interventional Radiology, Department of Radiology, University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, Sao Paulo, SP, 05403-000, Brazil
| | - Daniel Takeshi Setuguti
- Interventional Radiology, Department of Radiology, University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, Sao Paulo, SP, 05403-000, Brazil
| | - Joaquim Mauricio da Motta-Leal-Filho
- Interventional Radiology, Department of Radiology, Sao Paulo State Cancer Institute (ICESP), Av. Dr. Arnaldo, 251, Sao Paulo, SP, 01246-000, Brazil
| | - Marcos Roberto de Menezes
- Interventional Radiology, Department of Radiology, University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, Sao Paulo, SP, 05403-000, Brazil.,Interventional Radiology, Department of Radiology, Sao Paulo State Cancer Institute (ICESP), Av. Dr. Arnaldo, 251, Sao Paulo, SP, 01246-000, Brazil
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11
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Weihe R, Taghlabi K, Lowrance M, Reeves A, Jackson SR, Burton DC, El Atrouni W. Culture Yield in the Diagnosis of Native Vertebral Osteomyelitis: A Single Tertiary Center Retrospective Case Series with Literature Review. Open Forum Infect Dis 2022; 9:ofac026. [PMID: 35198644 PMCID: PMC8860156 DOI: 10.1093/ofid/ofac026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background Vertebral osteomyelitis is a serious condition that requires prompt diagnosis to avoid delays in proper management. There is no well-defined gold standard for diagnosis. We describe the current diagnostic approach at our institution, with a focus on the yield of image-guided vertebral biopsy. Methods We performed a single-centre 10-year retrospective case series, including adults with imaging suggestive of vertebral osteomyelitis/discitis, with either positive blood cultures, and/or a vertebral biopsy. We defined positive histopathology as our gold standard for test characteristic evaluation of biopsy cultures. Results Out of 694 patients identified, 221 met our inclusion criteria, and 173/221 (78.2%) patients underwent a spinal biopsy. Of those patients with biopsies, 113 (65%) had received antibiotics within 2 weeks preceding their evaluation. Six of 43 (13.9%) bone specimens were positive by culture, while 66/152 (43.4%) of disc specimens were culture positive. Forty-seven of 84 (55.9%) histopathology (bone or disc) specimens were diagnostic for osteomyelitis/discitis. The sensitivity of bone and disk culture were 30.0% and 56.0%, respectively, with specificities of 92.8% and 75.0%, respectively. Twenty-three (13.4%) patients had repeat biopsies, including 10 bone specimens and 14 disc specimens, and 11 (47.8%) specimens had histopathology performed which diagnosed an additional 3/23 patients (13% additional diagnostic yield). Conclusions Culture of percutaneous biopsy of disc resulted in the highest diagnostic yield. Histopathology added to the diagnostic yield in culture-negative specimens. Histopathologic evaluation of bone had better yield than bone culture. A repeat biopsy can add to the diagnostic yield.
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Affiliation(s)
- Rachel Weihe
- Assistant Professor of Internal Medicine, Division of Infectious Diseases, Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1028, Kansas City, KS 66160, USA
| | - Khaled Taghlabi
- Department of Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1011, Kansas City, KS 66160 USA
| | - Maren Lowrance
- Assistant Director for Medical Informatics and Enterprise Analytics, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3065, Kansas City, KS 66160 USA
| | - Alan Reeves
- Associate Professor and Director of Interventional Neuroradiology, Department of Radiology University of Kansas Medical Center, 3901 Rainbow Blvd, MS 4032, Kansas City, KS 66160 USA
| | - Sean R Jackson
- Associate Professor of Orthopedic Surgery, Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3017, Kansas City, KS 66160 USA
| | - Douglas C Burton
- Professor of Orthopedic Surgery, Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3017, Kansas City, KS 66160 USA
| | - Wissam El Atrouni
- Assistant Professor of Internal Medicine, Division of Infectious Diseases, Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1028, Kansas City, KS 66160, USA
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Non-specific spondylodiscitis: a new perspective for surgical treatment. 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 2022; 31:461-472. [PMID: 35031861 DOI: 10.1007/s00586-021-07072-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/10/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Pyogenic spondylodiscitis is a relatively rare spinal disease; non-specific spondylodiscitis (NSS) cases are increasing. This study aims to identify if changes of inflammatory markers under antibiotic therapy can be used to determine which NSS patients can benefit from surgical indication earlier than others. METHODS Two groups of patients with NSS were examined. Group A underwent surgery, while Group B was treated conservatively. Group B was also subdivided in patients undergoing antibiotic therapy for > 6 weeks (B1) and < 6 weeks (B2). Groups were compared for age, gender, BMI, blood levels of ESR and CRP and VAS scale. RESULTS There were no differences (P = 0.06) in reduction in ESR at 4 weeks between two main groups. A reduction in CRP, with < 2.7 mg/dl at 4 weeks, was observed in Group A (P = 0.01). Comparing Group B1 to B2, a reduction (P = 0.0001) in VAS, ESR and CRP at 4 weeks was observed in Group B2. It was possible to isolate the pathogen in 52.8% of Group B, without any differences on VAS, ESR and CRP values and on length of the antibiotic therapy. CONCLUSIONS The surgical treatment should be considered for patients who, after 4 weeks of conservative therapy, do not show a reduction in the ESR < 50 mm/h and of the CRP < 2.7 g/dl. The comparison between groups underwent surgically and those treated conservatively showed a reduction in the CRP at 4 weeks and better VAS for pain at 3 months in Group A.
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Larrieu-Jimenez P, Crenshaw N, Gonzalez JM, Ortega J. Progressive Lower Back Pain With New-Onset Symptoms. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Simpson AK, Lightsey HM, Xiong GX, Crawford AM, Minamide A, Schoenfeld AJ. Spinal endoscopy: evidence, techniques, global trends, and future projections. Spine J 2022; 22:64-74. [PMID: 34271213 DOI: 10.1016/j.spinee.2021.07.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/13/2021] [Accepted: 07/06/2021] [Indexed: 02/03/2023]
Abstract
The utilization of indirect visualization during procedures has been increasingly replacing traditional forms of direct visualization across many different surgical specialties. The adoption of arthroscopy, using small cameras placed inside joints, has transformed musculoskeletal care over the last several decades, allowing surgeons to provide the same anatomic solutions with less tissue dissection, resulting in lower requirements for inpatient care, reduced costs, and expedited recovery. For a variety of reasons, spine surgery has lagged behind other specialties in the adoption of indirect visualization. Nonetheless, patient demand for less invasive spine procedures and surgeon drive to provide these solutions and improve care quality has driven global adoption of spinal endoscopy. There are numerous endoscopic platforms and techniques currently utilized, and these systems are rapidly evolving. Additionally, the variance in technology and health system incentives across the globe has generated tremendous regional heterogeneity in the utilization of spinal endoscopic procedures. We present a consolidated review, including the background, evidence, techniques, and trends in spinal endoscopy, so that clinicians can gain a deeper understanding of this rapidly evolving domain of spinal healthcare.
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Affiliation(s)
- Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; Microendoscopic Spine Institute, 75 Francis St, Boston, MA 02115.
| | - Harry M Lightsey
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, 55 Fruit St., Boston, MA, 02114
| | - Grace X Xiong
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, 55 Fruit St., Boston, MA, 02114
| | - Alexander M Crawford
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, 55 Fruit St., Boston, MA, 02114
| | - Akihito Minamide
- Spine Center, Department of Orthopaedic Surgery, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko City, Tochigi, Japan
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
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Kafle G, Garg B, Mehta N, Sharma R, Singh U, Kandasamy D, Das P, Chowdhury B. Diagnostic yield of image-guided biopsy in patients with suspected infectious spondylodiscitis : a prospective study from a tuberculosis-endemic country. Bone Joint J 2022; 104-B:120-126. [PMID: 34969288 DOI: 10.1302/0301-620x.104b1.bjj-2021-0848.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aims of this study were to determine the diagnostic yield of image-guided biopsy in providing a final diagnosis in patients with suspected infectious spondylodiscitis, to report the diagnostic accuracy of various microbiological tests and histological examinations in these patients, and to report the epidemiology of infectious spondylodiscitis from a country where tuberculosis (TB) is endemic, including the incidence of drug-resistant TB. METHODS A total of 284 patients with clinically and radiologically suspected infectious spondylodiscitis were prospectively recruited into the study. Image-guided biopsy of the vertebral lesion was performed and specimens were sent for various microbiological tests and histological examinations. The final diagnosis was determined using a composite reference standard based on clinical, radiological, serological, microbiological, and histological findings. The overall diagnostic yield of the biopsy, and that for each test, was calculated in light of the final diagnosis. RESULTS The final diagnosis was tuberculous spondylodiscitis in 250 patients (88%) and pyogenic spondylodiscitis in 22 (7.8%). Six (2.1%) had a noninfectious condition-mimicking infectious spondylodiscitis, and six (2.1%) had no definite diagnosis and improved without specific treatment. The diagnosis was made by image-guided biopsy in 152 patients (56%) with infectious spondylodiscitis. Biopsy was contributory in identifying 132/250 patients (53%) with tuberculous spondylodiscitis, and 20/22 patients (91%) with pyogenic spondylodiscitis. Histological examination was the most sensitive diagnostic modality, followed by Xpert MTB/RIF assay. CONCLUSION Image-guided biopsy has a reasonably high diagnostic yield in patients with suspected infectious spondylodiscitis. A combination of histological examination, Xpert MTB/RIF assay, bacterial culture, and sensitivity provides high diagnostic accuracy in a country in which TB is endemic. Cite this article: Bone Joint J 2022;104-B(1):120-126.
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Affiliation(s)
- Gokul Kafle
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Nishank Mehta
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Urvashi Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Buddhadev Chowdhury
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Chargui M, Krzysztofiak A, Bernaschi P, De Marco G, Coulin B, Steiger C, Dayer R, Ceroni D. Presumptive bacteriological diagnosis of spondylodiscitis in infants less than 4 years by detecting K. kingae DNA in their oropharynx: Data from a preliminar two centers study. Front Pediatr 2022; 10:1046254. [PMID: 36568420 PMCID: PMC9780474 DOI: 10.3389/fped.2022.1046254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives Most cases of spondylodiscitis in children aged between 6 and 48 months old could be caused primarily by K. kingae. The present prospective study aimed to determine whether an innovative and indirect diagnosis approach - based on detection of K. kingae DNA in the oropharynx of children with suspected spondylodiscitis - provides sufficient evidence that this microorganism is responsible for the infection. Methods We prospectively analysed infants admitted for spondylodiscitis, considering above all the results of PCR realized in oropharyngeal swabs and in blood samples. Results Four of the 29 performed K. kingae-specific real-time PCR assay in blood were positive (13.8%), whereas 28 of the 32 K. kingae-specific real-time PCR assay realized on throat swabs were positive (87.5%). Conclusions This study demonstrates that performing oropharyngeal swab PCR is able to detect K. kingae in almost 90% of the toddlers with confirmed spondylodiscitis. That provides strong arguments for the hypothesis that K. kingae should be considered as the main aetiological pathogen to suspect in children between 6 and 48 months old with spondylodiscitis. Finally, it seems to us reasonable that oropharyngeal swab may become an early decision-making tool for the indirect identification of K. kingae in spondylodiscitis.
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Affiliation(s)
- Moez Chargui
- Unité D'orthopédie Pédiatrique et de Traumatologie Infantile, Service de Chirurgie Pédiatrique, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Andrzej Krzysztofiak
- Infectious Diseases Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Paola Bernaschi
- Microbiology Unit, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Giacomo De Marco
- Unité D'orthopédie Pédiatrique et de Traumatologie Infantile, Service de Chirurgie Pédiatrique, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Benoit Coulin
- Unité D'orthopédie Pédiatrique et de Traumatologie Infantile, Service de Chirurgie Pédiatrique, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Christina Steiger
- Unité D'orthopédie Pédiatrique et de Traumatologie Infantile, Service de Chirurgie Pédiatrique, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Romain Dayer
- Unité D'orthopédie Pédiatrique et de Traumatologie Infantile, Service de Chirurgie Pédiatrique, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Dimitri Ceroni
- Unité D'orthopédie Pédiatrique et de Traumatologie Infantile, Service de Chirurgie Pédiatrique, Hôpitaux Universitaires de Genève, Genève, Switzerland
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The potential of metagenomic next-generation sequencing in diagnosis of spinal infection: a retrospective study. 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 2021; 31:442-447. [PMID: 34677679 DOI: 10.1007/s00586-021-07026-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/02/2021] [Accepted: 10/11/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Metagenomic next-generation sequencing (mNGS) is a new approach to identify the infecting organism in infectious diseases. Our aim was to evaluate the accuracy of mNGS in determining the etiology of spinal infection. METHODS In this retrospective study, patients who had a suspected spinal infection and underwent mNGS for diagnosis in our hospital were eligible for inclusion. Samples for mNGS, culture, and histopathological tests were collected surgically or with a CT-guided needle biopsy. Sensitivity and specificity were calculated for mNGS and culture test, using histopathological results as reference. RESULTS A total of 31 mNGS tests in 30 cases were included. Twenty-six cases were classified as infected, and four cases were considered aseptic. mNGS achieved a specificity of 75.0% [95% confidence interval (CI), 21.9% to 98.7%], sensitivity was 70.3% (95% CI, 49.7% to 85.5%). mNGS was more sensitive than culture at 14.8% (95% CI, 4.9% to 34.6%, P < 0.0001). However, the specificities of mNGS and culture were statistically similar. CONCLUSION We described here the power of mNGS in the etiological diagnosing of spinal infection. Our study opens the possibility for more extensive use of mNGS techniques in the identification of pathogens in patients with suspected spinal infection.
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Clinicoradiographic predictors of percutaneous bone biopsy results among patients with suspected thoracolumbar spine infection. Skeletal Radiol 2021; 50:1801-1808. [PMID: 33576862 DOI: 10.1007/s00256-021-03735-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Image-guided percutaneous thoracolumbar spine biopsy is frequently performed in the setting of suspected septic facet arthritis or discitis osteomyelitis (DOM). There are limited data regarding factors associated with a positive biopsy result among these patients. MATERIALS AND METHODS Patients with suspected DOM who underwent spine biopsy were identified. Samples yielding a positive culture and/or histopathology suggestive of acute osteomyelitis were considered positive. The associations between selected medical comorbidities, laboratory values, pre-biopsy antibiotic administration, imaging findings and biopsy results were investigated. RESULTS 121 patients underwent percutaneous biopsy with 35.5% yielding positive results. Biopsy results showed no correlation with comorbidities. The only laboratory value that correlated with a positive biopsy yield was blood culture positivity (p = 0.03). The imaging findings that correlated with a positive biopsy yield were the presence of a paraspinal fluid collection or epidural abscess (p = 0.003 and 0.018, respectively). Sampling paraspinal fluid collections, when present, resulted in a higher rate of a positive biopsy yield compared to sampling of bone or disc (p = 0.006). Patients who received antibiotics had a higher rate of a positive biopsy yield (p = 0.014). In those with positive blood cultures, biopsy yielded the same antimicrobial susceptibility profile in 13/14 cases. CONCLUSION The presence of a paraspinal fluid collection or epidural abscess is correlated with positive biopsy yield, and paraspinal fluid collections should be targeted for biopsy. Other imaging findings did not correlate with biopsy yield. Biopsy may not offer additional information for patients with positive blood cultures.
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19
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Sousa R, Carvalho A, Santos AC, Abreu MA. Optimal microbiological sampling for the diagnosis of osteoarticular infection. EFORT Open Rev 2021; 6:390-398. [PMID: 34267930 PMCID: PMC8246105 DOI: 10.1302/2058-5241.6.210011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Infection is a dire complication afflicting every field of orthopaedics and traumatology. If specific clinical, laboratory and imaging parameters are present, infection is often assumed even in the absence of microbiological confirmation. However, apart from confirming infection, knowing the exact infecting pathogen(s) and their antimicrobial susceptibility patterns is paramount to help guide treatment. Every effort should therefore be undertaken with that goal in mind.Not all microbiological findings carry the same relevance, and knowing exactly how and where a sample was collected is key. Several different sampling techniques are available, and one must be aware of both advantages and limitations. Microbiological sampling alternatives in some of the most common clinical scenarios such as native and prosthetic joint infections, osteomyelitis and fracture-related infections, spinal and diabetic foot infections will be discussed.Orthopaedic surgeons should also be aware of basic laboratory sample processing techniques as they have a direct impact on the way specimens should be dealt with and transported to the laboratory. Only by knowing these basic principles will surgeons be able to participate in the multidisciplinary discussion and decision making around how to interpret microbiological findings in each specific patient. Cite this article: EFORT Open Rev 2021;6:390-398. DOI: 10.1302/2058-5241.6.210011.
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Affiliation(s)
- Ricardo Sousa
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Porto Bone and Joint Infection Group (GRIP), Centro Hospitalar Universitário do Porto and Grupo TrofaSaude, Portugal
| | - André Carvalho
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Cláudia Santos
- Porto Bone and Joint Infection Group (GRIP), Centro Hospitalar Universitário do Porto and Grupo TrofaSaude, Portugal.,Department of Microbiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Miguel Araújo Abreu
- Porto Bone and Joint Infection Group (GRIP), Centro Hospitalar Universitário do Porto and Grupo TrofaSaude, Portugal.,Department of Microbiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
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20
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Review article: the current status of CT-guided needle biopsy of the spine. Skeletal Radiol 2021; 50:281-299. [PMID: 32815040 DOI: 10.1007/s00256-020-03584-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 02/02/2023]
Abstract
CT-guided percutaneous needle biopsy of the spine is a well-described technique for determining the nature of indeterminate vertebral lesions or establishing a diagnosis of spinal infection, the high diagnostic accuracy and the safety of the procedure having been extensively documented. The purpose of the current article is to review the literature to date on CT-guided spinal biopsy. Specifically, indications for spinal biopsy, techniques for optimising yield, detail of the approaches for various spinal levels which is dependent upon both the region within the spinal column and lesion location within the vertebra (body vs. neural arch), determinants of biopsy outcome and complications are covered. It is hoped that the review will be of particular benefit to junior radiologists who are required to perform this procedure.
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21
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Kuo AH, Cho CH, Huang RY, Kim CJ, Lee TC. Target-specific yield rate and clinical utility of percutaneous tissue sampling in spinal infection. Clin Imaging 2020; 68:257-262. [DOI: 10.1016/j.clinimag.2020.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/04/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022]
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Refaat MI, Abdallah OY. Early surgical debridement and fixation for pyogenic lumbar spondylodiscitis. EGYPTIAN JOURNAL OF NEUROSURGERY 2020. [DOI: 10.1186/s41984-020-00094-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Management of pyogenic lumbar spondylodiscitis still represent a major conflict and challenge in neurosurgery due to different pathogens and the different methods available for management.
Objective
The aim of this study was to evaluate the outcome of posterior lumbar spinal fixation with debridement as a treatment modality in the management of pyogenic lumbar spondylodiscitis.
Patients and method
This is a prospective study conducted on patients presenting to the Neurosurgery Department of Cairo University hospitals diagnosed to have either spontaneous or iatrogenic pyogenic lumbar spondylodiscitis. All cases were operated upon by surgical debridement, drainage, and posterior lumbar fixation in the same setting. Antibiotics were prescribed according to the obtained culture and sensitivity. Laboratory follow-up was done to all patients. Clinical outcome was evaluated in terms of the Denis Functional Pain Scale. Follow-up period ranged from 5 to 14 months.
Results
A total of 25 patients comprised of 15 males and 9 females with a mean age of 45.7 years (range 32–63 years) were included in this study. Nine cases had a previous lumbar discectomy surgery, and 15 cases presented with spontaneous spondylodiscitis. L4–5 level was the most frequent site of pyogenic discitis. Excellent outcome and good outcomes (score 1–3 in Denis Functional Pain Scale) were reported in 84% of the patients and poor outcomes (score 4–5) in 16%.
Conclusion
Surgical fixation and debridement can be considered as an effective modality in the management of pyogenic lumbar spondylodiscitis with early ambulation, good control of pain, and early hospital discharge.
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Peckham ME, Shah LM, Johnson SM, Ryals E, Noda G, Hutchins TA. Defining Disc Biopsy Timing in Relation to Blood Culture Results for Inpatients with Suspected Discitis-Osteomyelitis. J Vasc Interv Radiol 2020; 32:121-127. [PMID: 33132028 DOI: 10.1016/j.jvir.2020.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/02/2020] [Accepted: 08/23/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To determine optimal timing of biopsy for suspected discitis-osteomyelitis (DOM) with respect to preliminary blood culture results and the effect of biopsy timing on hospital length of stay (LOS). MATERIALS AND METHODS This retrospective study reviewed disc/vertebral biopsies for suspected DOM performed between 2010 and 2018. A total of 107 disc/vertebral biopsies were performed on 96 inpatients (mean ± SD age 57.9 ± 14.5 years, 68 men/28 women) for suspected DOM, and 100 cases of DOM were clinically confirmed and treated. Descriptive and regression statistics were performed with LOS as the primary outcome. RESULTS Of disc biopsies in clinically confirmed cases, 68% were positive; 20% of all biopsies had preliminary positive blood cultures after 2 hospital days. There was no difference in LOS between cases with biopsy performed ≤ 2 days after blood culture and cases with biopsy performed > 2 days after blood culture (P = .40). Regression analysis showed no association between positive biopsy results and sepsis, white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), or C-reactive protein (CRP). Biopsy yield was not significantly decreased in patients previously taking antibiotics (P = .09). CONCLUSIONS Waiting 2 days for preliminary blood culture results could avoid disc/vertebral biopsy in 20% of patients and does not significantly impact hospital LOS. Additionally, clinical factors (sepsis, WBC count, CRP, and ESR) do not have predictive value for positive disc biopsy results.
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Affiliation(s)
- Miriam E Peckham
- Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, 30 North, 1900 East #1A071, Salt Lake City, UT 84132-2140.
| | - Lubdha M Shah
- Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, 30 North, 1900 East #1A071, Salt Lake City, UT 84132-2140
| | | | - Elizabeth Ryals
- Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, 30 North, 1900 East #1A071, Salt Lake City, UT 84132-2140
| | - Grace Noda
- Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, 30 North, 1900 East #1A071, Salt Lake City, UT 84132-2140
| | - Troy A Hutchins
- Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, 30 North, 1900 East #1A071, Salt Lake City, UT 84132-2140
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Wong H, Tarr GP, Rajpal K, Sweetman L, Doyle A. The impact of antibiotic pre-treatment on diagnostic yield of CT-guided biopsy for spondylodiscitis: A multi-centre retrospective study and meta-analysis. J Med Imaging Radiat Oncol 2020; 65:146-151. [PMID: 33118317 DOI: 10.1111/1754-9485.13118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Patients with suspected spondylodiscitis often undergo CT-guided biopsy to identify a causative microbiological organism. Antibiotic pre-treatment has been postulated as a cause for a negative biopsy, although previous clinical studies have been heterogenous with a meta-analysis suggesting no effect. The aim of this study was to assess the impact of antibiotic pre-treatment on microbiological yield. METHODS Retrospective review of consecutive adult patients undergoing CT-guided biopsy for suspected spondylodiscitis in two tertiary centres between 2010 and 2016. Demographic, procedural and clinical data were collected. Antibiotic pre-treatment was ascertained from patient drug charts. RESULTS Over the 6-year period, 104 biopsies in 104 patients were included. 51% had a positive microbiological yield at CT-guided biopsy, with the most common isolated organism being Staphylococcus aureus (10.6%). Over two thirds of patients (69.3%) were off antibiotics at time of biopsy. There was no significant difference in microbiological yield in those patients on versus off antibiotics (48.2% vs 54.2%, P = 0.55). 10.6% patients had a final diagnosis of Mycobacterium tuberculosis spondylodiscitis, and this organism was significantly associated with a positive microbiological yield (90.9% vs 46.2%, P = 0.01). There was an inverse association between the presence of fever and sepsis with positive microbiological yield. CONCLUSIONS CT-guided biopsy in suspected spondylodiscitis obtains a positive microbiological yield in about half of patients. This was significantly higher in patients diagnosed with tuberculosis spondylodiscitis, but there was no significant difference with antibiotic pre-treatment. Therefore, antibiotic pre-treatment should not preclude clinicians from pursuing a microbiological sample through CT-guided biopsy.
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Affiliation(s)
- Hayley Wong
- Radiology Department, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Gregory P Tarr
- Radiology Department, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Kunaal Rajpal
- Radiology Department, Auckland Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Lara Sweetman
- Radiology Department, Auckland Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Anthony Doyle
- Radiology Department, Auckland Hospital, Auckland District Health Board, Auckland, New Zealand
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Al Ohaly R, Ranganath N, Saffie MG, Shroff A. Listeria spondylodiscitis: an uncommon etiology of a common condition; a case report. BMC Infect Dis 2020; 20:559. [PMID: 32736610 PMCID: PMC7395412 DOI: 10.1186/s12879-020-05286-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/22/2020] [Indexed: 01/24/2023] Open
Abstract
Background Listeriosis is a severe food-borne infection caused by the Gram-positive rod, Listeria monocytogenes. Despite the low incidence (3–8 cases per million), Listeriosis has a case fatality rate of 20–30% as it occurs predominantly in immunocompromised individuals at extremes of age, diabetics and pregnant women. Listeriosis classically presents as a febrile gastroenteritis, isolated bacteremia, meningitis, or maternal-fetal infections. Focal bone and joint infection are rare and primarily involve orthopedic implant devices. Here, we present the first case of Listeria-associated spondylodiscitis. Case presentation A 79-year-old male presents with acute-on-chronic back pain in the absence of risk factors or exposures, aside from age. On radiological imaging, spondylodiscitis of L3-L4 was diagnosed. Subsequently, a CT-guided biopsy was performed to aid in confirming microbiological aetiology. Listeria monocytogenes was grown in culture and patient received appropriate antibacterial therapy. Conclusion The case highlights the utility of image-guided tissue sampling in aiding diagnosis and management in patients with vertebral osteomyelitis. It also encourages consideration of uncommon organisms such as Listeria as an etiology of vertebral osteomyelitis, even in the absence of prosthetic implants.
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Affiliation(s)
- Rand Al Ohaly
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | | | | | - Anjali Shroff
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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Diffre C, Jousset C, Roux AL, Duran C, Noussair L, Rottman M, Carlier RY, Dinh A. Predictive factors for positive disco-vertebral biopsy culture in pyogenic vertebral osteomyelitis, and impact of fluoroscopic versus scanographic guidance. BMC Infect Dis 2020; 20:512. [PMID: 32677896 PMCID: PMC7364507 DOI: 10.1186/s12879-020-05223-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/02/2020] [Indexed: 01/28/2023] Open
Abstract
Background The aims of this study were to identify the predictive factors for microbiological diagnosis through disco-vertebral biopsy (DVB) in patients with pyogenic vertebral osteomyelitis (PVO) and negative blood cultures, and compare the performance of DVB under fluoroscopic versus scanographic guidance. Methods We performed a cohort study comparing positive and negative DVB among patients with PVO. All cases of PVO undergoing a DVB for microbiological diagnosis in our center were retrospectively reviewed. Infections due to Mycobacterium tuberculosis, infections on foreign device, and non-septic diseases were excluded. Anamnestic, clinical, biological, microbiological, as well as radiological data were collected from medical charts thanks to a standardized data set. Results A total of 111 patients were screened; 88 patients were included. Microbiological cultures were positive in 53/88 (60.2%) patients. A thickening of the paravertebral tissue ≥10 mm on magnetic resonance imaging (MRI) in axial MR scans was a predictive factor of DVB microbiological positivity (52.4% vs. 13.3%; p = 0.006; OR = 5.4). Overall, 51 DVB were performed under fluoroscopic guidance and 37 under scanographic guidance. Considering lumbar DVB, 25/36 (69.4%) of cases yielded positive results under fluoroscopic guidance versus 5/15 (33.3%) under scanographic guidance (p = 0.02; OR = 4.4). No adverse event linked to DVB was notified. Conclusion Every patient with PVO and negative blood cultures should undergo a DVB. A thickening of the paravertebral tissue ≥10 mm on MRI is associated with a higher rate of positive DVB culture. A lumbar DVB under fluoroscopic guidance is more sensitive than under scanographic guidance to identify the micro-organism involved.
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Affiliation(s)
- Caroline Diffre
- Department of medical imaging, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, 92380, Garches, France
| | - Camille Jousset
- Department of medical imaging, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, 92380, Garches, France
| | - Anne-Laure Roux
- Microbiology laboratory, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, 92380, Garches, France
| | - Clara Duran
- Infectious disease unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, 104, boulevard Raymond Poincaré, 92380, Garches, France
| | - Latifa Noussair
- Microbiology laboratory, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, 92380, Garches, France
| | - Martin Rottman
- Microbiology laboratory, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, 92380, Garches, France
| | - Robert-Yves Carlier
- Department of medical imaging, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, 92380, Garches, France
| | - Aurélien Dinh
- Infectious disease unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, 104, boulevard Raymond Poincaré, 92380, Garches, France.
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Ryang YM, Akbar M. [Pyogenic spondylodiscitis: symptoms, diagnostics and therapeutic strategies]. DER ORTHOPADE 2020; 49:691-701. [PMID: 32642943 DOI: 10.1007/s00132-020-03945-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pyogenic spondylodiscitis is a rare disease that is being diagnosed with increasing frequency in recent years. It is associated with a high morbidity and mortality. DIAGNOSIS Often, because of its nonspecific symptoms, pyogenic spondylodiscitis is diagnose with some delay. In addition to pathogen detection, MRI is the gold standard to diagnose pyogenic spondylodiscitis. Also, x-ray imaging and CT can be carried out for surgical planning and for subsequent follow-up imaging. If blood or tissue cultures are negative, open surgical biopsies should be preferred over CT-guided biopsies. THERAPY The therapy can be conservative, such as immobilization, as well as antibiotics and analgesics, or surgical. If, for example, neurological deficits, spinale instabilities or deformities, septic disease progression or extensive abscess formations are present, surgical therapy is indicated. The surgical treatment strategies depend on the severity of the disease. OUTLOOK The prognosis is dependent on a rapid diagnosis and a swift start to therapy. There is no clear evidence with regard to treatment options (conservative vs. surgical therapy).
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Affiliation(s)
- Y-M Ryang
- Klinik für Neurochirurgie und Zentrum für Wirbelsäulentherapie, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Deutschland.
| | - M Akbar
- Clinic für Wirbelsäulenerkrankungen und -Therapien, MEOCLINIC, Berlin, Deutschland
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Role of Image-Guided Biopsy in the Diagnosis and Antimicrobial Management of Vertebral Osteomyelitis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee SA, Chiu CK, Chan CYW, Yaakup NA, Wong JHD, Kadir KAA, Kwan MK. The clinical utility of fluoroscopic versus CT guided percutaneous transpedicular core needle biopsy for spinal infections and tumours: a randomized trial. Spine J 2020; 20:1114-1124. [PMID: 32272253 DOI: 10.1016/j.spinee.2020.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Biopsy is important to obtain microbiological and histopathological diagnosis in spine infections and tumors. To date, there have been no prospective randomized trials comparing fluoroscopic guided and computed tomography (CT) transpedicular biopsy techniques. The goal of this study was to evaluate the accuracy, safety, and diagnostic outcome of these two diagnostic techniques. PURPOSE To evaluate the accuracy, safety, and diagnostic outcome of fluoroscopic guided and CT transpedicular biopsy techniques. STUDY DESIGN Prospective randomized trial. PATIENT SAMPLE Sixty consecutive patients with clinical symptoms and radiological features suggestive of spinal infection or malignancy were recruited and randomized into fluoroscopic or CT guided spinal biopsy groups. Both groups were similar in terms of patient demographics, distribution of spinal infections and malignancy cases, and the level of biopsies. OUTCOME MEASURES The primary outcome measure was diagnostic accuracy of both methods, determined based on true positive, true negative, false positive, and false negative biopsy findings. Secondary outcome measures included radiation exposure to patients and doctors, complications, and postbiopsy pain score. METHODS A transpedicular approach was performed with an 8G core biopsy needle. Specimens were sent for histopathological and microbiological examinations. Diagnosis was made based on biopsy results, clinical criteria and monitoring of disease progression during a 6-month follow up duration. Clinical criteria included presence of risk factors, level of inflammatory markers and magnetic resonance imaging findings. Radiation exposure to patients and doctors was measured with dosimeters. RESULTS There was no significant difference between the diagnostic accuracy of fluoroscopic and CT guided spinal biopsy (p=0.67) or between the diagnostic accuracy of spinal infection and spinal tumor in both groups (p=0.402 for fluoroscopy group and p=0.223 for CT group). Radiation exposure to patients was approximately 26 times higher in the CT group. Radiation exposure to doctors in the CT group was approximately 2 times higher compared to the fluoroscopic group if a lead shield was not used. Lead shields significantly reduced radiation exposure to doctors anywhere from 2 to 8 times. No complications were observed for either group and the differences in postbiopsy pain scores were not significant. CONCLUSIONS The accuracy, procedure time, complication rate and pain score for both groups were similar. However, radiation exposure to patients and doctors were significantly higher in the CT group without lead protection. With lead protection, radiation to doctors reduced significantly.
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Affiliation(s)
- She Ann Lee
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia.
| | - Nur Adura Yaakup
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeannie Hsiu Ding Wong
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khairul Azmi Abd Kadir
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
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Kihira S, Koo C, Mahmoudi K, Leong T, Mei X, Rigney B, Aggarwal A, Doshi AH. Combination of Imaging Features and Clinical Biomarkers Predicts Positive Pathology and Microbiology Findings Suggestive of Spondylodiscitis in Patients Undergoing Image-Guided Percutaneous Biopsy. AJNR Am J Neuroradiol 2020; 41:1316-1322. [PMID: 32554421 DOI: 10.3174/ajnr.a6623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/23/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Pathology and microbiology results for suspected spondylodiscitis on MR imaging are often negative in up to 70% of cases. We aimed to predict whether MR imaging features will add diagnostic value when combined with clinical biomarkers to predict positive findings of spondylodiscitis on pathology and/or microbiology from percutaneous biopsy. MATERIALS AND METHODS In this retrospective single-center institutional review board-approved study, patients with radiologically suspected spondylodiscitis and having undergone percutaneous biopsies were assessed. Demographic characteristics, laboratory values, and tissue and blood cultures were collected. Pathology and microbiology results were used as end points. Three independent observers provided MR imaging-based scoring for typical MR imaging features for spondylodiscitis. Multivariate logistic regression and receiver operating characteristic analysis were performed to determine an optimal combination of imaging and clinical biomarkers in predicting positive findings on pathology and/or microbiology from percutaneous biopsy suggestive of spondylodiscitis. RESULTS Our patient cohort consisted of 72 patients, of whom 33.3% (24/72) had spondylodiscitis. The mean age was 63 ± 16 years with a male/female ratio of 41:31. Logistic regression revealed a combination with an area under the curve of 0.72 for pathology and 0.68 for pathology and/or microbiology. Epidural enhancement on MR imaging improved predictive performance to 0.87 for pathology and 0.78 for pathology and/or microbiology. CONCLUSIONS Our findings demonstrate that epidural enhancement on MR imaging added diagnostic value when combined with clinical biomarkers to help predict which patients undergoing percutaneous biopsy will have positive findings for spondylodiscitis on pathology and/or microbiology.
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Affiliation(s)
- S Kihira
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - C Koo
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - K Mahmoudi
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - T Leong
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - X Mei
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - B Rigney
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - A Aggarwal
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - A H Doshi
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
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Abstract
In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 17 focused on the use of antibiotics in spine surgery, for which this article provides the recommendations, voting results, and rationales.
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Yeh KJ, Husseini JS, Hemke R, Nelson SB, Chang CY. CT-guided discitis-osteomyelitis biopsies with negative microbiology: how many days should we wait before repeating the biopsy? Skeletal Radiol 2020; 49:619-623. [PMID: 31760457 DOI: 10.1007/s00256-019-03344-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/30/2019] [Accepted: 11/10/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the number of days to positive CT-guided biopsy sample culture in patients with discitis-osteomyelitis. METHODS Our study was IRB approved and HIPAA compliant. All CT-guided biopsies performed for acute discitis-osteomyelitis with positive microbiology between 2002 and 2018 were reviewed. Microbiological organism and days to positive biopsy were documented. Mean, median, skew, and standard deviation were calculated. The proportion of positive cultures that become positive after each day has elapsed was also calculated. RESULTS There were 96 true positive cultures, with 64 (67%) male and 32 (33%) female, ages 57 ± 18 (range 19-87) years. Overall, including all culture results, the mean number of days to positive culture was 2.9 ± 3.5 days. The median number of days was 2, with a positive skew of 2.9. At days 1, 2, 3, 4, and 5, 48%, 68%, 78%, 85%, and 89%, respectively, of biopsy samples had a positive microbiology culture. CONCLUSION Approximately three-quarters of discitis-osteomyelitis pathogens will be identified by biopsy sample culture by 3 days after CT-guided biopsy. This finding should be considered if planning for a repeat biopsy in the setting of a negative microbiology culture.
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Affiliation(s)
- Kaitlyn J Yeh
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
| | - Jad S Husseini
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
| | - Robert Hemke
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
| | - Sandra B Nelson
- Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 20114, USA
| | - Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
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Schirò S, Foreman SC, Bucknor M, Chin CT, Joseph GB, Link TM. Diagnostic Performance of CT-Guided Bone Biopsies in Patients with Suspected Osteomyelitis of the Appendicular and Axial Skeleton with a Focus on Clinical and Technical Factors Associated with Positive Microbiology Culture Results. J Vasc Interv Radiol 2020; 31:464-472. [PMID: 32007416 DOI: 10.1016/j.jvir.2019.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/30/2019] [Accepted: 08/09/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To assess diagnostic performance of CT-guided percutaneous needle bone biopsy (CTNBB) in patients with suspected osteomyelitis and analyze whether certain clinical or technical factors were associated with positive microbiology results. MATERIALS AND METHODS All CTNBBs performed in a single center for suspected osteomyelitis of the appendicular and axial skeleton during 2003-2018 were retrospectively reviewed. Specific inclusion criteria were clinical and radiologic suspicion of osteomyelitis. Standard of reference was defined using outcome of surgical histopathology and microbiology culture and clinical and imaging follow-up. Technical and clinical data (needle size, comorbidities, clinical factors, laboratory values, blood cultures) were collected. Logistic regression was performed to assess associations between technical and clinical data and microbiology biopsy outcome. RESULTS A total of 142 CTNBBs were included (46.5% female patients; age ± SD 46.10 y ± 22.8), 72 (50.7%) from the appendicular skeleton and 70 (49.3%) from the axial skeleton. CTNBB showed a sensitivity of 42.5% (95% confidence interval [CI], 32.0%-53.6%) in isolating the causative pathogen. A higher rate of positive microbiology results was found in patients with intravenous drug use (odds ratio [OR] = 5.15; 95% CI, 1.2-21.0; P = .022) and elevated white blood cell count ≥ 10 × 109/L (OR = 3.9; 95% CI, 1.62-9.53; P = .002). Fever (≥ 38°C) was another clinical factor associated with positive microbiology results (OR = 3.6; 95% CI, 1.3-9.6; P = .011). CONCLUSIONS CTNBB had a low sensitivity of 42.5% for isolating the causative pathogen. Rate of positive microbiology samples was significantly higher in patients with IV drug use, elevated white blood cell count, and fever.
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Affiliation(s)
- Silvia Schirò
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California; Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy.
| | - Sarah C Foreman
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Matthew Bucknor
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Cynthia T Chin
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Gabby B Joseph
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
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Yeraagunta T, Yerramneni VK, Kanala RR, Gaikwad G, Kumar HDP, Phutane AS. Minimally invasive spinal fusion and decompression for thoracolumbar spondylodiscitis. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:17-21. [PMID: 32549707 PMCID: PMC7274357 DOI: 10.4103/jcvjs.jcvjs_24_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 11/08/2022] Open
Abstract
Objective: The objective was to study the results of the treatment of thoracolumbar spondylodiscitis (SD) through minimally invasive fusion and decompression technique. Materials and Methods: All the patients were evaluated clinically and radiologically (X-ray, magnetic resonance imaging, and computed tomography scan) along with necessary laboratory investigations. They underwent the minimally invasive spinal (MIS) decompression and fusion procedure using tubular retractor system and percutaneous transpedicular fixation done under fluoroscopy guidance. They were assessed using pre- and postoperative Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Kirkaldy-Willis functional outcome criteria. Postoperative radiological assessment of fusion was done. Operating time and fluoroscopy duration were also studied. Results: There were a total of 12 patients, with an equal sex ratio of 1:1 with 8 and 4 patients having the involvement of the lumbar and dorsal spine, respectively. The fixation was done in the involved vertebrae in 8 patients and adjacent normal vertebrae in 4 patients. There was an improvement in VAS score from 7.8 to 2.1 and ODI from 64.3 to 16.4. 4 patients had excellent, 7 had good, and 1 had fair outcome in Kirkaldy-Willis functional outcome criteria. There was Grade 2 and 3 fusion in 4 cases each, and 2 patients had Grade 4 fusion. The laboratory studies were found positive for tuberculosis in 3 cases with 7 having necrotizing granulomatous inflammation, and 2 patients had negative results. Conclusion: The MIS procedure is a safe and effective method of the management of SD in the thoracolumbar spine.
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Affiliation(s)
- Thirumal Yeraagunta
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Ramanadha Reddy Kanala
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Govind Gaikwad
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - H D Pradeep Kumar
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Aniket Sharad Phutane
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Affiliation(s)
- Kartik Shenoy
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
| | - Amit Singla
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Afshin E Razi
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
| | - Yong H Kim
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
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Russo A, Graziano E, Carnelutti A, Sponza M, Cadeo B, Sartor A, Righi E, Bassetti M. Management of vertebral osteomyelitis over an eight-year period: The UDIPROVE (UDIne PROtocol on VErtebral osteomyelitis). Int J Infect Dis 2019; 89:116-121. [PMID: 31629078 DOI: 10.1016/j.ijid.2019.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/07/2019] [Accepted: 10/11/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Vertebral osteomyelitis (VO) is a compelling clinical entity for clinicians because of its insidious and indolent course, which makes diagnosis difficult. METHODS All patients with a suspected diagnosis of VO were analyzed over an 8-year period (January 2009 to January 2017). The UDIPROVE protocol (UDIne PROtocol on VErtebral osteomyelitis) was applied in all cases. The primary endpoint was the performance of the UDIPROVE protocol to obtain the causal bacteria of infection. RESULTS During the study period, 133 episodes of confirmed VO were observed. The etiology of infection was obtained in 73.6% of cases: 70.5% were gram-positive, 16.3% were gram-negative, and 13.2% were mycobacteria. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) showed that for tubercular VO, the median standard uptake value (SUV) was higher when compared with VO caused by other bacteria. Clinical cure at the end of therapy was reported in 85.7% of patients. Previous antimicrobial therapy and a delay of more than 5 days in performing biopsy were associated with an undiagnosed etiology of VO. Targeted antibacterial therapy and follow-up with FDG-PET/CT were associated with clinical cure at the end of therapy, while the involvement of more than two vertebrae and inadequate drainage were associated with failure. CONCLUSIONS Rigorous application of the UDIPROVE protocol allowed the causative pathogens of VO to be obtained - at about twice the rate reported in the literature. The use of FDG-PET/CT for the follow-up of infection was more reliable when compared to magnetic resonance imaging (MRI).
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Affiliation(s)
- Alessandro Russo
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Elena Graziano
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Alessia Carnelutti
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Massimo Sponza
- Division of Vascular and Interventional Radiology, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Barbara Cadeo
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Assunta Sartor
- Microbiology Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Elda Righi
- Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, Genoa and Hospital Policlinico San Martino - IRCCS, Genoa, Italy.
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Joint EANM/ESNR and ESCMID-endorsed consensus document for the diagnosis of spine infection (spondylodiscitis) in adults. Eur J Nucl Med Mol Imaging 2019; 46:2464-2487. [PMID: 31399800 DOI: 10.1007/s00259-019-04393-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/04/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Diagnosis of spondylodiscitis (SD) may be challenging due to the nonspecific clinical and laboratory findings and the need to perform various diagnostic tests including serologic, imaging, and microbiological examinations. Homogeneous management of SD diagnosis through international, multidisciplinary guidance would improve the sensitivity of diagnosis and lead to better patient outcome. METHODS An expert specialist team, comprising nuclear medicine physicians appointed by the European Association of Nuclear Medicine (EANM), neuroradiologists appointed by the European Society of Neuroradiology (ESNR), and infectious diseases specialists appointed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), reviewed the literature from January 2006 to December 2015 and proposed 20 consensus statements in answer to clinical questions regarding SD diagnosis. The statements were graded by level of evidence level according to the 2011 Oxford Centre for Evidence-based Medicine criteria and included in this consensus document for the diagnosis of SD in adults. The consensus statements are the result of literature review according to PICO (P:population/patients, I:intervention/indicator, C:comparator/control, O:outcome) criteria. Evidence-based recommendations on the management of adult patients with SD, with particular attention to radiologic and nuclear medicine diagnosis, were proposed after a systematic review of the literature in the areas of nuclear medicine, radiology, infectious diseases, and microbiology. RESULTS A diagnostic flow chart was developed based on the 20 consensus statements, scored by level of evidence according to the Oxford Centre for Evidence-based Medicine criteria. CONCLUSIONS This consensus document was developed with a final diagnostic flow chart for SD diagnosis as an aid for professionals in many fields, especially nuclear medicine physicians, radiologists, and orthopaedic and infectious diseases specialists.
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Ang MT, Wong GR, Wong DR, Clements W, Joseph T. Diagnostic yield of computed tomography‐guided biopsy and aspiration for vertebral osteomyelitis. J Med Imaging Radiat Oncol 2019; 63:589-595. [DOI: 10.1111/1754-9485.12923] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Megan T Ang
- Department of Radiology Alfred Hospital Melbourne Victoria Australia
| | - Geoffrey R Wong
- Department of Medicine Royal Melbourne Hospital Melbourne Victoria Australia
| | - Davy R Wong
- Department of Medicine University of Notre Dame Sydney New South Wales Australia
| | - Warren Clements
- Department of Radiology Alfred Hospital Melbourne Victoria Australia
- Department of Surgery Monash University Melbourne Victoria Australia
| | - Tim Joseph
- Department of Radiology Alfred Hospital Melbourne Victoria Australia
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Minimally invasive spine surgery in the treatment of pyogenic spondylodiscitis: an initial retrospective series study. Wideochir Inne Tech Maloinwazyjne 2019; 14:333-339. [PMID: 31119002 PMCID: PMC6528123 DOI: 10.5114/wiitm.2018.78891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 08/14/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Pyogenic spondylodiscitis is a bacterial infection affecting the intervertebral disc and its adjacent vertebrae. Although relatively rare, it is a challenging medical disease with a poor prognosis that requires immediate diagnosis and treatment with suitable antibiotics. Aim To evaluate the clinical outcome of minimally invasive spine surgery (MIS) for pyogenic spondylodiscitis. Material and methods The retrospective study cohort consisted of 10 consecutive patients who had undergone MIS decompression and/or discectomy for thoracic or lumbar pyogenic spondylodiscitis in our hospital. Data including patient characteristics, symptoms, visual analog scale (VAS) score, surgical approach and postoperative outcomes were obtained for retrospective analysis. Results Between January 2005 and December 2013, 10 patients underwent MIS decompression in the Department of Orthopedics in our medical university. Seven of these patients had lumbar infections and 3 had thoracic infections. All 10 patients had improved VAS scores immediately after surgery and after discharge. The VAS score (respectively on postoperative day 1 and day 7) suggested that the patients in this study had significantly less pain than preoperatively (day 1: 5 vs. 9, p < 0.001; day 7: 2.9 vs. 9, p < 0.001). The organism was obtained in 10 (100%) patients by the operative cultures. All patients achieved an excellent clinical recovery without the need for further spine surgery. All patients underwent postoperative imaging during follow-up and showed complete resolution or dramatically improved magnetic resonance imaging changes. Conclusions Minimally invasive spine surgery is a safe and effective surgical approach for pyogenic spondylodiscitis.
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Özmen D, Özkan N, Guberina N, Fliessbach K, Suntharalingam S, Theysohn J, Büchter M, Forsting M, Buer J, Dudda M, Jäger M, Wetter A. Computed-tomography-guided biopsy in suspected spondylodiscitis: Single-center experience including 201 biopsy procedures. Orthop Rev (Pavia) 2019; 11:7793. [PMID: 30996840 PMCID: PMC6452088 DOI: 10.4081/or.2019.7793] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/27/2018] [Indexed: 02/07/2023] Open
Abstract
Our propose is to evaluate CT-guided biopsies in suspected spondylodiscitis with respect to puncture site, microbiology findings, histopathology findings and impact on antibiotic therapy. 86 CT-guided spine interventions in suspected spondylodiscitis comprising 201 biopsy procedures were analyzed. Medical records of all patients were screened for microbiology and histopathology reports as well as date, duration and kind of antibiotic therapy. Statistical analyses included calculation of Chi2-tests and logistic regression analyses. Locations of biopsies were intervertebral disc (48.3%), paravertebral soft-tissue (38.3%) and vertebral body (10.9%). Positive microbiological findings were found altogether in 33.8% of cases, positive histopathological findings in 53.6%. Significant associations between positive microbiological findings, positive histopathological findings and antibiotic therapy, respectively, were found. Location of biopsies did not significantly influence rate of positive findings. From the variables age, white blood cell count, serum creatinine and puncture site, none were found to be an independent predictor for a positive microbiological result. We concluded that CT-guided biopsy of intervertebral disc and paravertebral soft tissue yields positive microbiologic findings in a significant proportion of cases. Puncture site is not associated with positive results of microbiology or histopathology.
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Affiliation(s)
- Derya Özmen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen
| | - Neriman Özkan
- Department of Neurosurgery, University Hospital Essen
| | - Nika Guberina
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen
| | - Klaus Fliessbach
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital, Bonn
| | | | - Jens Theysohn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen
| | | | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen
| | - Jan Buer
- Institute of Medical Microbiology, University Hospital Essen
| | - Marcel Dudda
- Department of Orthopedic and Trauma Surgery, University of Duisburg-Essen, Essen, Germany
| | - Marcus Jäger
- Department of Orthopedic and Trauma Surgery, University of Duisburg-Essen, Essen, Germany
| | - Axel Wetter
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen
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Iwata E, Scarborough M, Bowden G, McNally M, Tanaka Y, Athanasou NA. The role of histology in the diagnosis of spondylodiscitis. Bone Joint J 2019; 101-B:246-252. [DOI: 10.1302/0301-620x.101b3.bjj-2018-0491.r2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to determine the diagnostic utility of histological analysis in spinal biopsies for spondylodiscitis (SD). Patients and Methods Clinical features, radiology, results of microbiology, histology, and laboratory investigations in 50 suspected SD patients were evaluated. In 29 patients, the final (i.e. treatment-based) diagnosis was pyogenic SD; in seven patients, the final diagnosis was mycobacterial SD. In pyogenic SD, the neutrophil polymorph (NP) infiltrate was scored semi-quantitatively by determining the mean number of NPs per (×400) high-power field (HPF). Results Of the 29 pyogenic SD patients, 17 had positive microbiology and 21 positive histology (i.e. one or more NPs per HPF on average). All non-SD patients showed less than one NP per HPF. The presence of one or more NPs per HPF had a diagnostic sensitivity of 72.4%, specificity 100%, accuracy 100%, positive predictive value (PPV) 81.0%, and negative predictive value (NPV) 61.9%. Sensitivity, specificity, and accuracy were greater using the criterion of positive histology and/or microbiology than positive histology or microbiology alone. Granulomas were identified histologically in seven mycobacterial SD patients, and positive microbiology was detected in four. Conclusion The diagnosis of pyogenic SD was more often confirmed by positive histology (one or more NPs per HPF on average) than by microbiology, although diagnostic sensitivity was greater when both histology and microbiology were positive. Cite this article: Bone Joint J 2019;101-B:246–252.
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Affiliation(s)
- E. Iwata
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
| | - M. Scarborough
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - G. Bowden
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M. McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Y. Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - N. A. Athanasou
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
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Filippiadis DK, Charalampopoulos G, Mazioti A, Keramida K, Kelekis A. Bone and Soft-Tissue Biopsies: What You Need to Know. Semin Intervent Radiol 2018; 35:215-220. [PMID: 30402003 DOI: 10.1055/s-0038-1669467] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Percutaneous, image-guided musculoskeletal biopsy, due to its minimal invasive nature, when compared with open surgical biopsy, is a safe and effective technique which is widely used in many institutions as the primary method to acquire tissue and bone samples. Indications include histopathologic and molecular assessment of a musculoskeletal lesion, exclusion of malignancy in a bone/vertebral fracture, examination of bone marrow, and infection investigation. Preprocedural workup should include both imaging (for lesion assessment and staging) and laboratory (including coagulation tests and platelet count) studies. In selected cases, antibiotic prophylaxis should be administered before the biopsy. Core needle biopsy of musculoskeletal lesions has a diagnostic accuracy that ranges from 66 to 98% with higher diagnostic yield for lytic, large-size, malignant lesions and when multiple and long specimens are obtained. Reported complication rates range between 0 and 10% and usually do not exceed 5%, with a suggested threshold of 2%. The purpose of this review article is to illustrate the technical aspects, the indications, and the methodology of percutaneous image-guided bone biopsy that will assist the interventional radiologist to perform these minimal invasive techniques.
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Affiliation(s)
- Dimitrios K Filippiadis
- 2nd Radiology Department, "ATTIKON" University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Charalampopoulos
- 2nd Radiology Department, "ATTIKON" University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyro Mazioti
- 2nd Radiology Department, "ATTIKON" University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kalliopi Keramida
- Heart Failure Unit, "ATTIKON" University General Hospital, National and Kapodistrian University of Athens, Greece
| | - Alexis Kelekis
- 2nd Radiology Department, "ATTIKON" University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Lopez J, Tournadre A, Couderc M, Pereira B, Soubrier M, Dubost JJ. No change in the efficacy of infectious spondylodiscitis bacteriological testing over 20 years period. Joint Bone Spine 2018; 85:637-638. [DOI: 10.1016/j.jbspin.2017.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/05/2017] [Indexed: 11/25/2022]
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Dayer R, Alzahrani MM, Saran N, Ouellet JA, Journeau P, Tabard-Fougère A, Martinez-Álvarez S, Ceroni D. Spinal infections in children: a multicentre retrospective study. Bone Joint J 2018; 100-B:542-548. [PMID: 29629576 DOI: 10.1302/0301-620x.100b4.bjj-2017-1080.r1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims This multicentre, retrospective study aimed to improve our knowledge of primary pyogenic spinal infections in children by analyzing a large consecutive case series. Patients and Methods The medical records of children with such an infection, treated at four tertiary institutions between 2004 and 2014, were analyzed retrospectively. Epidemiological, clinical, paraclinical, radiological, and microbiological data were evaluated. There were 103 children, of whom 79 (76.7%) were aged between six months and four years. Results We confirmed a significant male predominance in the incidence of primary pyogenic spinal infections in children (65%). The lumbar spine was the most commonly affected region, and 27 infections (26.2%) occurred at L4/5. The white blood cell count was normal in 61 children (59%), and the CRP level was normal in 43 (42%). Blood cultures were performed in 95 children, and were positive in eight (8%). A total of 20 children underwent culture of biopsy or aspiration material, which was positive in eight (40%). Methicillin-sensitive Staphylococcus aureus (MSSA) and Kingella ( K.) kingae were the most frequently isolated pathogens. Conclusion MSSA remains the most frequently isolated pathogen in children with primary pyogenic infection of the spine, but K. kingae should be considered as an important pathogen in children aged between six months and four years. Therefore, an empirical protocol for antibiotic treatment should be used, with consideration being made for the triphasic age distribution and specific bacteriological aetiology. In the near future, the results of polymerase chain reaction assay on throat swabs may allow the indirect identification of K. kingae spondylodiscitis in young children and thus aid early treatment. However, these preliminary results require validation by other prospective multicentre studies. Cite this article: Bone Joint J 2018;100-B:542-8.
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Affiliation(s)
- R Dayer
- Division of Paediatric Orthopaedics, University Hospitals of Geneva, 6 Rue Willy Donzé, 1211 Geneva 14, Switzerland
| | - M M Alzahrani
- Division of Orthopaedics, McGill University and Imam Abdulrahman Bin Faisal University, 845 Rue Sherbrooke O, Montréal, QC H3A 0G4, Canada
| | - N Saran
- Division of Orthopaedics, McGill University, Montreal, Canada
| | - J A Ouellet
- Division of Orthopaedics, McGill University, Montreal, Canada
| | - P Journeau
- Division of Paediatric Orthopaedic Surgery, Children's Hospital, Rue du Morvan, 54511 Vandoeuvre-les-Nancy Cedex, France
| | - A Tabard-Fougère
- Division of Paediatric Orthopaedics, University Hospitals of Geneva, 6 Rue Willy Donzé, 1211 Geneva 14, Switzerland
| | - S Martinez-Álvarez
- Servicio de Cirugía Ortopédica y Traumatología Infantil, Hospital Universitario Infantil Niño Jesús, Av. de Menéndez Pelayo, 65, 28009 Madrid, Spain
| | - D Ceroni
- Division of Paediatric Orthopaedics, University Hospitals of Geneva, 6 Rue Willy Donzé, 1211 Geneva 14, Switzerland
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Knipp D, Simeone FJ, Nelson SB, Huang AJ, Chang CY. Percutaneous CT-guided sacroiliac joint sampling for infection: aspiration, biopsy, and technique. Skeletal Radiol 2018; 47:473-482. [PMID: 29143113 DOI: 10.1007/s00256-017-2809-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/26/2017] [Accepted: 10/23/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate methods of CT-guided sacroiliac joint sampling in patients with suspected infection. MATERIALS AND METHODS All CT-guided sacroiliac joint sampling procedures for suspected infection were reviewed for sampling type (aspiration, lavage aspiration, biopsy), microbiology results, and clinical and imaging follow-up. The primary gold standard was anatomic pathology. If pathology was not available, then positive blood culture with the same organism as SIJ sampling, imaging and clinical follow-up, or clinical follow-up only were used. Anterior and posterior joint distention was evaluated by MRI within 7 days of the procedure. RESULTS A total of 34 patients (age 39 ± 20 (range, 6-75) years; 21 F, 13 M) were included. Aspiration samples only were obtained in 13/34 (38%) cases, biopsy samples only in 9/34 (26%) cases, and both samples in 12/34 (35%) cases. There was an overall 54% sensitivity and 86% specificity. For the aspiration samples, sensitivity and specificity were 60 and 81%, respectively, compared to 45 and 90% for the biopsy samples. In cases with both samples, biopsy did not add additional microbial information. Seventeen (17/34, 50%) patients had an MRI. The anterior joint was more distended than the posterior joint in 15/17 (88%) of patients, and this difference was significant (P = 0.0003). All of these 17 patients had an attempted aspiration by a posterior approach; 6/17 (35%) resulted in a successful aspiration. CONCLUSIONS Aspiration of the sacroiliac joint has a higher sensitivity than biopsy and should always be attempted first. MRI may be helpful for procedure planning.
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Affiliation(s)
- David Knipp
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
| | - F Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
| | - Sandra B Nelson
- Infectious Disease Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ambrose J Huang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
| | - Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
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Lack of effect of antibiotics on biopsy culture results in vertebral osteomyelitis. Diagn Microbiol Infect Dis 2018; 91:273-274. [PMID: 29573841 DOI: 10.1016/j.diagmicrobio.2018.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/16/2018] [Accepted: 02/21/2018] [Indexed: 10/17/2022]
Abstract
We report a retrospective study of 173 patients with vertebral osteomyelitis evaluating the effect of antibiotics administered prior to percutaneous and open biopsy cultures. Antibiotics given prior to these biopsies did not have a significant effect on the yield of cultures.
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Kasalak Ö, Wouthuyzen-Bakker M, Adams HJA, Overbosch J, Dierckx RAJO, Jutte PC, Kwee TC. CT-guided biopsy in suspected spondylodiscitis: microbiological yield, impact on antimicrobial treatment, and relationship with outcome. Skeletal Radiol 2018; 47:1383-1391. [PMID: 29663026 PMCID: PMC6105146 DOI: 10.1007/s00256-018-2944-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/19/2018] [Accepted: 04/02/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the clinical impact of CT-guided biopsy, as performed in routine clinical practice, in patients with suspected spondylodiscitis on MRI in terms of culture yield, impact on antimicrobial treatment, and outcome. METHODS This study included 64 patients with MRI findings compatible with spondylodiscitis who underwent CT-guided biopsy. RESULTS Initial CT-guided biopsies were culture-positive in 20/64 (31.3%, 95% confidence interval [CI] 21.2-43.3%). Repeat CT-guided biopsies (after initial negative biopsy) were culture-positive in an additional 5/15 (33.3%, 95% CI 15.2-58.3%). Serum leukocytes, C-reactive protein, pre-biopsy use of antibiotics, neurological symptoms, MRI findings, vertebral height loss, and hyperkyphosis were not significantly different between culture-positive and culture-negative cases (P = 0.214-1.000); 75% (15/20) of initial CT-guided biopsies that were culture-positive provided additional information to clinicians for guiding antibiotic treatment. Sixty-two of 64 patients (96.9%, 95% CI 89.3-99.1%) would have been adequately treated if a strategy was followed that would subject all patients without clinical findings suspicious for "atypical" microorganisms and negative blood cultures to empirical antibiotics (i.e., clindamycin for coverage of Gram-positive bacteria) without using biopsy results to determine the optimal antibiotic regimen. Outcome within 6 months (development of neurologic or orthopedic complications, surgery, and death) was not significantly different (P = 0.751) between culture-positive and culture-negative patients. CONCLUSIONS Although CT-guided biopsies are culture-positive in a minority of cases, the majority of positive cultures are useful to tailor antibiotic treatment. Empirical treatment with clindamycin may cover almost all micro-organisms in positive biopsy specimens, provided patients are not immunocompromised. Outcome appears similar between culture-positive and culture-negative patients.
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Affiliation(s)
- Ömer Kasalak
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hugo J. A. Adams
- Department of Radiology and Nuclear Imaging, Deventer Hospital, Deventer, The Netherlands
| | - Jelle Overbosch
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Rudi A. J. O. Dierckx
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Paul C. Jutte
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thomas C. Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands
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Herren C, Jung N, Pishnamaz M, Breuninger M, Siewe J, Sobottke R. Spondylodiscitis: Diagnosis and Treatment Options. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:875-882. [PMID: 29321098 PMCID: PMC5769318 DOI: 10.3238/arztebl.2017.0875] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 05/19/2017] [Accepted: 10/16/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND A recent population-based study from Denmark showed that the incidence of spondylodiscitis rose from 2.2 to 5.8 per 100 000 persons per year over the period 1995-2008; the age-standardized incidence in Germany has been estimated at 30 per 250 000 per year on the basis of data from the Federal Statistical Office (2015). The early diagnosis and treatment of this condition are essential to give the patient the best chance of a good outcome, but these are often delayed because it tends to present with nonspecific manifestations, and fever is often absent. METHODS This article is based on a systematic search of Medline and the Cochrane Library for the period January 2009 to March 2017. Of the 788 articles identified, 30 publications were considered. RESULTS The goals of treatment for spondylodiscitis are to eliminate infection, restore functionality of the spine, and relieve pain. Magnetic resonance imaging (MRI) remains the gold standard for the radiological demonstration of this condition, with 92% sensitivity and 96% specificity. It also enables visualization of the spatial extent of the infection and of abscess formation (if present). The most common bacterial cause of spondylodiscitis in Europe is Staphylococcus aureus, but tuberculous spondylodiscitis is the most common type worldwide. Antibiotic therapy is a pillar of treatment for spondylodiscitis and should be a part of the treatment in all cases. Neurologic deficits, sepsis, an intraspinal empyema, the failure of conservative treatment, and spinal instability are all indications for surgical treatment. CONCLUSION The quality of life of patients who have been appropriately treated for spondylodiscitis has been found to be highly satisfactory in general, although back pain often persists. The risk of recurrence increases in the presence of accompanying illnesses such as diabetes mellitus, renal failure, or undrained epidural abscesses.
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Affiliation(s)
- Christian Herren
- Department for Trauma and Reconstructive Surgery, University Hospital RWTH Aachen
| | - Norma Jung
- Department I for Internal Medicine, University Hospital Cologne
| | - Miguel Pishnamaz
- Department for Trauma and Reconstructive Surgery, University Hospital RWTH Aachen
| | | | - Jan Siewe
- Center of Orthopedic and Trauma Surgery, University Hospital Cologne
| | - Rolf Sobottke
- Center of Orthopedic and Trauma Surgery, University Hospital Cologne
- Center for Orthopaedics and Trauma Surgery, Rhein-Maas Klinikum GmbH, Würselen
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Intensity of 18F-FDG PET Uptake in Culture-Negative and Culture-Positive Cases of Chronic Osteomyelitis. CONTRAST MEDIA & MOLECULAR IMAGING 2017; 2017:9754293. [PMID: 29114183 PMCID: PMC5660764 DOI: 10.1155/2017/9754293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/07/2017] [Indexed: 11/17/2022]
Abstract
Microbiologic cultures are not infrequently negative in patients with a histopathologic diagnosis of chronic osteomyelitis. Culture-negative cases may represent low-grade infections with a lower metabolic activity than culture-positive cases. 18F-FDG PET could potentially detect such a difference. We determined whether the level of 18F-FDG PET uptake differs in patients with culture-negative and culture-positive osteomyelitis. We reviewed the clinical charts of 40 consecutive patients, who had diagnostic 18F-FDG PET for a suspected bone infection. Twenty-six patients were eligible with a confirmed diagnosis based on microbiologic cultures and/or histopathologic examination. Sixteen of 26 patients had chronic osteomyelitis. Eight of them had positive cultures, seven had negative cultures, and one patient had no cultures of the biopsy specimen. The patients with histologically and/or microbiologically proven osteomyelitis were correctly interpreted as true positive in the routine clinical reading of 18F-FDG PET images. There was no relationship between the level of 18F-FDG PET uptake and the presence of positive or negative bacterial cultures. The result favors the concept that that culture-negative cases of osteomyelitis are false-negative infections due to nonculturable microbes. 18F-FDG PET may help to confirm the presence of metabolically active infection in these patients and guide their appropriate treatment.
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McNamara AL, Dickerson EC, Gomez-Hassan DM, Cinti SK, Srinivasan A. Yield of Image-Guided Needle Biopsy for Infectious Discitis: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2017; 38:2021-2027. [PMID: 28882866 DOI: 10.3174/ajnr.a5337] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/07/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Image-guided biopsy is routinely conducted in patients with suspected discitis, though the sensitivity reported in the literature ranges widely. PURPOSE We applied a systematic review and meta-analysis to estimate the yield of image-guided biopsy for infectious discitis. DATA SOURCES We performed a literature search of 4 data bases: PubMed, Cochrane CENTRAL Register of Controlled Trials, Embase.com, and Scopus from data base inception to March 2016. STUDY SELECTION A screen of 1814 articles identified 88 potentially relevant articles. Data were extracted for 33 articles, which were eligible if they were peer-reviewed publications of patients with clinical suspicion of discitis who underwent image-guided biopsy. DATA ANALYSIS Patients with positive cultures out of total image-guided biopsy procedures were pooled to estimate yield with 95% confidence intervals. Hypothesis testing was performed with an inverse variance method after logit transformation. DATA SYNTHESIS Image-guided biopsy has a yield of approximately 48% (793/1763), which is significantly lower than the open surgical biopsy yield of 76% (152/201; P < .01). Biopsy in patients with prior antibiotic exposure had a yield of 32% (106/346), which was not significantly different from the yield of 43% (336/813; P = .08) in patients without prior antibiotic exposure. LIMITATIONS The conclusions of this meta-analysis are primarily limited by the heterogeneity of the included studies. CONCLUSIONS Image-guided biopsy has a moderate yield for the diagnosis of infectious discitis, which is significantly lower than the yield of open surgical biopsy. This yield is not significantly affected by prior antibiotic use.
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Affiliation(s)
- A L McNamara
- From the University of Michigan Health System (A.L.M., D.M.G.-H., S.K.C., A.S.), Ann Arbor, Michigan
| | - E C Dickerson
- University of California, San Francisco (E.C.D.), San Francisco, California
| | - D M Gomez-Hassan
- From the University of Michigan Health System (A.L.M., D.M.G.-H., S.K.C., A.S.), Ann Arbor, Michigan
| | - S K Cinti
- From the University of Michigan Health System (A.L.M., D.M.G.-H., S.K.C., A.S.), Ann Arbor, Michigan
| | - A Srinivasan
- From the University of Michigan Health System (A.L.M., D.M.G.-H., S.K.C., A.S.), Ann Arbor, Michigan
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