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Wangaryattawanich P, Condos AM, Rath TJ. Bacterial and Viral Infectious Disease of the Spine. Magn Reson Imaging Clin N Am 2024; 32:313-333. [PMID: 38555143 DOI: 10.1016/j.mric.2023.12.003] [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] [Indexed: 04/02/2024]
Abstract
Spinal infections are a diverse group of diseases affecting different compartments of the spine with variable clinical and imaging presentations. Diagnosis of spinal infections is based on a combination of clinical features, laboratory markers, and imaging studies. Imaging plays a pivotal role in the diagnosis and management of spinal infections. The characteristic imaging manifestations of bacterial and viral infections in the spine are discussed with key teaching points emphasized.
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Affiliation(s)
- Pattana Wangaryattawanich
- Department of Radiology, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195-7115, USA.
| | - Amy M Condos
- Department of Radiology, University of Washington School of Medicine, 2545 Northeast 85th Street Seattle, WA 98115, USA
| | - Tanya J Rath
- Neuroradiology Section, Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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2
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Crombé A, Fadli D, Clinca R, Reverchon G, Cevolani L, Girolami M, Hauger O, Matcuk GR, Spinnato P. Imaging of Spondylodiscitis: A Comprehensive Updated Review-Multimodality Imaging Findings, Differential Diagnosis, and Specific Microorganisms Detection. Microorganisms 2024; 12:893. [PMID: 38792723 PMCID: PMC11123694 DOI: 10.3390/microorganisms12050893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/11/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
Spondylodiscitis is defined by infectious conditions involving the vertebral column. The incidence of the disease has constantly increased over the last decades. Imaging plays a key role in each phase of the disease. Indeed, radiological tools are fundamental in (i) the initial diagnostic recognition of spondylodiscitis, (ii) the differentiation against inflammatory, degenerative, or calcific etiologies, (iii) the disease staging, as well as (iv) to provide clues to orient towards the microorganisms involved. This latter aim can be achieved with a mini-invasive procedure (e.g., CT-guided biopsy) or can be non-invasively supposed by the analysis of the CT, positron emission tomography (PET) CT, or MRI features displayed. Hence, this comprehensive review aims to summarize all the multimodality imaging features of spondylodiscitis. This, with the goal of serving as a reference for Physicians (infectious disease specialists, spine surgeons, radiologists) involved in the care of these patients. Nonetheless, this review article may offer starting points for future research articles.
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Affiliation(s)
- Amandine Crombé
- Department of Musculoskeletal Imaging, Pellegrin University Hospital, Bordeaux University, Place Amélie Raba-Léon, F-33000 Bordeaux, France
| | - David Fadli
- Department of Musculoskeletal Imaging, Pellegrin University Hospital, Bordeaux University, Place Amélie Raba-Léon, F-33000 Bordeaux, France
| | - Roberta Clinca
- Department of Radiology, IRCCS Policlinico di Sant’Orsola, 40138 Bologna, Italy
| | - Giorgio Reverchon
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Luca Cevolani
- Orthopedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Girolami
- Department of Spine Surgery Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Olivier Hauger
- Department of Musculoskeletal Imaging, Pellegrin University Hospital, Bordeaux University, Place Amélie Raba-Léon, F-33000 Bordeaux, France
| | - George R. Matcuk
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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3
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Chevalerias M, Coiffier G, Darrieutort-Laffite C, Godot S, Ottaviani S, Henry J, Brochard J, Cormier G, Couderc M, Hoppe E, Mulleman D, Khatchatourian L, Le Thuaut A, Bart G, Le Goff B. Association between radiographic and functional outcome in vertebral osteomyelitis SPONDIMMO, a 6-month prospective multicenter cohort. Joint Bone Spine 2023; 90:105600. [PMID: 37330001 DOI: 10.1016/j.jbspin.2023.105600] [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: 02/20/2023] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES This study aimed to describe radiographic and functional evolution over 6 months in a large cohort of VO patients. METHODS We prospectively recruited patients with VO from 2016 to 2019 in 11 French centers. X-rays were performed at baseline, 3 months, and 6 months to assess progression using structural and static criteria. Functional impairment was evaluated using the Oswestry Disability Index (ODI) at 3 months and 6 months. RESULTS Two hundred and twenty-two patients were included. Mean age was 67.8±14 years, mostly men (67.6%). After 3 months, there was a significant increase in vertebral fusion (16.4% vs 52.7%), destruction of vertebral bodies (10.1% vs 22.8%), and of all the static features (frontal angulation (15.2% vs 24.4%), segmental (34.6% vs 56%) and regional (24.5% vs 41%) kyphosis). From 3 to 6 months, among the different X-ray abnormalities, only the complete fusion progressed significantly (16.6% vs 27.2%). Median ODI showed significant improvement from 3 to 6 months (24, IQR [11.5-38] vs 16, IQR [6-34]). At 6 months, 14.1% of the patients had a severe disability, 2% a major disability. The persistence of vertebral destruction at 6 months was associated with a higher ODI (16, IQR [7.5-30.5] vs 27, IQR [11.5-44.5]). No differences in radiological progression were observed with immobilization using a rigid brace. CONCLUSION Our study demonstrates structural and static radiographic progression after 3 months. Only the complete fusion progressed over the long-term. Functional impairment was associated with persistence of vertebral destruction.
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Affiliation(s)
| | | | | | - Sophie Godot
- Department of Rheumatology, AP-HP DCSS, Paris, France
| | | | - Julien Henry
- Department of Rheumatology, AP-HP Bicêtre, Paris, France
| | - Julia Brochard
- Department of Infectious Diseases, CH de Saint-Nazaire, Saint-Nazaire, France
| | - Grégoire Cormier
- Department of Rheumatology, CHD de Vendée, La Roche-sur-Yon, France
| | - Marion Couderc
- Department of Rheumatology, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Hoppe
- Department of Rheumatology, CHU d'Angers, Angers, France
| | | | - Lydie Khatchatourian
- Department of Internal Medicine and Infectious Disease, CH de Cornouaille, Quimper, France
| | - Aurélie Le Thuaut
- Direction of Research, Methodology and Biostatistics Platform, CHU de Nantes, Nantes, France
| | - Géraldine Bart
- Department of Rheumatology and Internal Medicine, Percy Military Training Hospital, Paris, France
| | - Benoit Le Goff
- Department of Rheumatology, CHU de Nantes, Nantes, France
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4
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Raghavan M, Palestro CJ. Imaging of Spondylodiscitis: An Update. Semin Nucl Med 2023; 53:152-166. [PMID: 36522190 DOI: 10.1053/j.semnuclmed.2022.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
Spondylodiscitis is an infection of the vertebral body and/or intervertebral disc, which can also involve the epidural space, posterior elements, and paraspinal soft tissues. Due to high morbidity and mortality, prompt diagnosis and treatment of spondylodiscitis is critical. However, diagnosis can be challenging due to nonspecific signs and symptoms. Magnetic resonance imaging with and without contrast is the imaging modality of choice due to high sensitivity and specificity. Intravenous administration of gadolinium contrast can better demonstrate the extent of soft tissue and bone abscesses. However, magnetic resonance imaging is less useful in the evaluation of treatment response. When magnetic resonance imaging cannot be performed or is not diagnostic, radionuclide imaging is a useful alternative. Although bone scintigraphy frequently is used as a screening test, false negative results can occur early in the course of the infection and in the elderly. This test is not useful for detecting the soft tissue infections that often accompany or mimic spondylodiscitis. Gallium-67 citrate improves the specificity of the bone scan, can detect infection earlier than the bone scan, may be more sensitive, especially in elderly patients, and identifies accompanying soft tissue infection. Performing SPECT and SPECT/CT improve accuracy. The 2-3 day delay between radiopharmaceutical administration, poor image quality, and relatively high patient radiation dose are significant disadvantages of gallium-67. Furthermore gallium-67 is no longer as readily available as it once was. 18F-FDG imaging is the radionuclide test of choice for spondylodiscitis. The procedure, completed in one day, is sensitive, has a high negative predictive value, and reliably differentiates degenerative from infectious vertebral body end-plate abnormalities. 18F-FDG has outperformed bone and gallium-67 imaging in comparative studies. 18F-FDG may be able to provide an objective means for monitoring response to treatment. The potential of other agents for diagnosing spondylodiscitis has been studied. Although indium-111biotin accurately diagnoses spondylodiscitis, this radiopharmaceutical has never been commercially available. Gallium-68 citrate and 99mTc-radiolabeled antimicrobial peptides have been investigated, but their role in the diagnosis of spondylodiscitis has not been established. Labeled leukocyte scintigraphy has no role in the diagnosis of spondylodiscitis.
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Affiliation(s)
- Meera Raghavan
- Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, Gilbert, AZ.
| | - Christopher J Palestro
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
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5
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Kim WJ, Park C, Sarraf K. Management of vertebral osteomyelitis in adults. Br J Hosp Med (Lond) 2023; 84:1-5. [PMID: 36708343 DOI: 10.12968/hmed.2022.0362] [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: 01/19/2023]
Abstract
Vertebral osteomyelitis is a condition that predominantly affects older men with chronic comorbidities, such as diabetes, renal and hepatic failure, or immunosuppression. Symptoms develop insidiously and a high index of suspicion is required to diagnose the condition; this is achieved through serological testing and imaging. The mainstay of treatment is long-term antibiotic therapy, lasting a minimum of 6 weeks; however, surgical debridement with stabilisation is required when conservative treatment is proving ineffective and infection progresses. It is critically important that sufficient treatment is provided for those experiencing vertebral osteomyelitis, as not doing so could lead to severe neurological compromise and death.
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Affiliation(s)
- Woo Jae Kim
- Department of Trauma and Orthopaedics, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Chang Park
- Department of Trauma and Orthopaedics, Northwest Thames Rotation, London, UK
| | - Khaled Sarraf
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
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6
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Heyde CE, Spiegl UJA, Voelker A, von der Hoeh N, Henkelmann J. Imaging in the Diagnosis of Nonspecific Pyogenic Spondylodiskitis. J Neurol Surg A Cent Eur Neurosurg 2023; 84:69-76. [PMID: 32911551 DOI: 10.1055/s-0040-1709168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The prevalence of nonspecific pyogenic spondylodiskitis, associated with both a high morbidity and a high mortality, has increased in the last few decades. The diagnosis is often delayed because of the nonspecific clinical manifestation at the early stage. The reliability of radiographs is limited, particularly in early stage after the onset of infection. Computed tomography (CT) can reliably assess the bony condition with the possibility of spatial visualization. Contrast enhancement supports the detection of affected soft tissue. Magnetic resonance imaging (MRI) continues to be the gold standard in the diagnosis of spondylodiskitis. Sophisticated investigation protocols supported by gadolinium enhancement secure the diagnosis. MRI has a high resolution without radiation exposure. Different nuclear investigation techniques extend the diagnostic options. Reports of 18F-fluorodeoxyglucose-positron emission tomography (18-FDG-PET) are particularly promising to confirm the diagnosis. The drawback of the reduced image quality with respect to detailed anatomical information can be overcome by a combined simultaneous acquisition of CT or MRI. With respect to one of the greatest challenges, the differentiation between degenerative changes (Modic type 1) and infection at an early stage using differentiated MRI protocols and FDG-PET is promising. This overview presents a concise state-of-the-art look at radiologic investigations in case of suspected nonspecific pyogenic spondylodiskitis with the focus on a pragmatic approach.
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Affiliation(s)
- Christoph Eckhard Heyde
- Department of Orthopedics, Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
| | | | - Anna Voelker
- Department of Orthopedics, Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
| | - Nicolas von der Hoeh
- Department of Orthopedics, Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
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Chianca V, Chalian M, Harder D, Del Grande F. Imaging of Spine Infections. Semin Musculoskelet Radiol 2022; 26:387-395. [PMID: 36103882 DOI: 10.1055/s-0042-1749619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The incidence of spondylodiskitis has increased over the last 20 years worldwide, especially in the immunodepressed population, and it remains a complex pathology, both in terms of diagnosis and treatment. Because clinical symptoms are often nonspecific and blood culture negative, imaging plays an essential role in the diagnostic process. Magnetic resonance imaging, in particular, is the gold standard technique because it can show essential findings such as vertebral bone marrow, disk signal alteration, a paravertebral or epidural abscess, and, in the advanced stage of disease, fusion or collapse of the vertebral elements. However, many noninfectious spine diseases can simulate spinal infection. In this article, we present imaging features of specific infectious spine diseases that help radiologists make the distinction between infectious and noninfectious processes.
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Affiliation(s)
- Vito Chianca
- Clinica di Radiologia EOC IIMSI, Lugano, Switzerland.,Ospedale Evangelico Betania, Naples, Italy
| | - Majid Chalian
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, Washington
| | - Dorothee Harder
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
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8
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Maamari J, Tande A, Diehn F, Tai DBG, Berbari E. Diagnosis of vertebral osteomyelitis. J Bone Jt Infect 2022; 7:23-32. [PMID: 35136714 PMCID: PMC8814828 DOI: 10.5194/jbji-7-23-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/06/2022] [Indexed: 12/19/2022] Open
Abstract
Native vertebral osteomyelitis (NVO) is a potentially fatal infection which
has seen a gradual increase in its incidence over the past decades. The
infection is insidious, presenting with symptoms of back pain. Fever is
present in about 60 % of patients. Prompt diagnosis of NVO is important to
prevent the development of complications. Numerous laboratory and imaging
tools can be deployed to accurately establish the diagnosis. Imaging
techniques such as magnetic resonance, nuclear imaging, and computed
tomography are essential in diagnosing NVO but can also be useful in
image-guided biopsies. Laboratory tools include routine blood tests,
inflammatory markers, and routine culture techniques of aspirated specimens.
Recent advances in molecular techniques can assist in identifying offending
pathogen(s). In this review, we detail the arsenal of techniques that can be
utilized to reach a diagnosis of NVO.
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Affiliation(s)
- Julian Maamari
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Aaron J. Tande
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Felix Diehn
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Elie F. Berbari
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
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9
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Poutoglidou F, Metaxiotis D, Saloupis P, Mpeletsiotis A. Operative Treatment of Adult Pyogenic Spondylodiscitis: A Retrospective Study of 32 Cases. Cureus 2021; 13:e14820. [PMID: 34094774 PMCID: PMC8171352 DOI: 10.7759/cureus.14820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 12/29/2022] Open
Abstract
Background Spondylodiscitis is a potentially life-threatening infection that imposes a significant financial burden on healthcare systems. Current reports suggest an increase in the incidence of spondylodiscitis, which could be attributed to the aging population and the growing rates of drug abuse. This study aims to evaluate the safety and effectiveness of surgical treatment of spondylodiscitis. Materials and methods Thirty-two cases diagnosed with spondylodiscitis and treated operatively between 2010 and 2015 were enrolled in this study. Indications for surgery were progressive neurologic involvement, progressive spinal deformity or instability, impending fracture, epidural abscess, and poor response to antibiotics. Patients underwent a single-stage procedure. A combined anterior and posterior approach was used in 28 of the patients. In 20 patients, a titanium mesh cage was used for reconstruction. The mean follow-up was 5.6 years. Results There were 18 males and 14 females. The mean age of the patients was 68.4 years (range 56-78). The cervical spine was affected in two cases (6.3%), the thoracic spine in 12 cases (37.5%), and the lumbar spine in 18 cases (56.3%). The most commonly isolated microorganisms were Staphylococcus aureus and Escherichia coli. There was neither mortality nor severe complications. Fusion was achieved in all the patients. There was complete resolution of the neurologic deficits that were recorded preoperatively. No signs of recurrent or residual infection were recorded until the last follow-up. Conclusions Our data suggest that early detection and surgical intervention of spondylodiskitis is associated with favorable outcomes.
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Affiliation(s)
- Frideriki Poutoglidou
- Orthopaedic Department, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, GRC
| | - Dimitrios Metaxiotis
- Orthopaedic Department, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, GRC
| | - Panagiotis Saloupis
- Orthopaedic Department, Hippokratio General Hospital of Thessaloniki, Thessaloniki, GRC
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10
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Abstract
AbstractMusculoskeletal infection can be an urgent or emergent clinical issue. Accurate imaging diagnosis is an essential part of the treatment algorithm. This review addresses advantages of available imaging modalities and radiologic appearance of the various manifestations of infection. Controversies are addressed, including the use of the term “osteitis.” Finally, the differential diagnosis of infection is reviewed, such as inflammatory arthropathies and tumors that can simulate infection on imaging exams.
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11
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Kim CH, Ju CI, Lee SM, Kim SW. Efficacy of Antibiotic-Loaded Cement Augmentation for Correcting Low Grade Pedicle Screw Loosening. Korean J Neurotrauma 2021; 17:41-47. [PMID: 33981642 PMCID: PMC8093028 DOI: 10.13004/kjnt.2021.17.e2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/23/2020] [Accepted: 12/08/2020] [Indexed: 12/18/2022] Open
Abstract
Objective Altered biomechanics and bone fragility can contribute to pedicle screw loosening. This study aimed to evaluate the efficacy of antibiotic-loaded cement augmentation for correcting symptomatic screw loosening as a minimally invasive alternative to open revision surgery. Methods Ten consecutive patients who underwent percutaneous cement augmentation for pedicle screw loosening were included in this study. Low grade pedicle screw loosening was deemed clinically relevant in cases of continuous back pain with significant radiolucent halo zones at a vertebral level without screw backing out or stripping. We analyzed the screw loosening at the main location of halo formation. All patients were treated by fluoroscopy-guided antibiotic-loaded cement augmentation of the loosened pedicle screws. Patient demographics and pre- and postoperative data were also assembled and analyzed. Results Most (80%) halo formation locations were the inferior type. Augmentation was technically feasible in all but one patient, in whom the procedure was unsuccessful due to access difficulty. This patient ultimately underwent percutaneous screw re-implantation via a different trajectory. The other nine patients in whom cement filling was satisfactory reported significant pain relief at the final follow-up. Moreover, no severe complications such as wound infection or repeated screw loosening occurred during the follow-up period. Conclusion The most common halo formation location was the inferior type. In cases without access difficulty, antibiotic-loaded cement augmentation for the treatment of low grade pedicle screw loosening can relieve pain and avoid extensive open surgery.
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Affiliation(s)
- Chi Ho Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Chang Il Ju
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Sung Myung Lee
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Seok Won Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
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12
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Heyde CE, Lübbert C, Wendt S, Rodloff A, Völker A, von NHDH. Spinal Tuberculosis. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 160:74-83. [PMID: 33477180 DOI: 10.1055/a-1285-4994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Tuberculosis is one of the most common infectious diseases worldwide. The frequency in Germany is low, however, an increase has been observed in the past few years. The incidence of extrapulmonary manifestation accounts for up to 10 to 20%. In 50% of these cases the spinal column is affected. Although literature reveals worldwide experiences in the treatment, in Germany spinal tuberculosis remains a rarity. Different pitfalls and specific characteristics regarding diagnosis and therapy are to consider. Therefore, a presentation of these specifics and their discussion based on the available literature will be presented. The purpose is to achieve an increase in awareness regarding this, in our latitudes, rare disease.
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Affiliation(s)
- Christoph Eckhard Heyde
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Christoph Lübbert
- Department of Oncology, Gastroenterology, Hepatology, Respiratory Medicine, Infectiology, Infectious Disease and Tropical Medicine Section, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Sebastian Wendt
- Department of Oncology, Gastroenterology, Hepatology, Respiratory Medicine, Infectiology, Infectious Disease and Tropical Medicine Section, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Arne Rodloff
- Institute of Medical Microbiology and Infection Epidemiology, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Anna Völker
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Nicolas H der Höh von
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig Medical Faculty, Leipzig, Germany
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13
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QUEIROZ GUSTAVOLUCIOBARBOSADE, FERNANDES ELOYDEAVILA, GARCIA ANDRÉSOUSA, PINTO IGORPELLUCCI, GODOY GABRIELPARISDE, CURTO DAVIDDEL, UETA RENATOHIROSHISALVIONI, PUERTAS EDUARDOBARROS, DELL’AQUILA ADRIANAMACEDO. CORRELATION BETWEEN FINDINGS IN MAGNETIC RESONANCE AND BIOPSY IN THE DIAGNOSIS OF SPONDYLODISCITIS. COLUNA/COLUMNA 2020. [DOI: 10.1590/s1808-185120201902220257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective To correlate magnetic resonance imaging (MRI) findings with the microbiological and anatomopathological diagnosis of spinal infection. Methods A retrospective, cohort review of online medical records (laboratory, anatomopathology and diagnostic imaging sector) of patients diagnosed with spondylodiscitis, who underwent a full spine MR scan between January 2014 and July 2018 at the Department of Orthopedics and Traumatology of the Universidade Federal de São Paulo. Results Staphylococcus aureus was the most commonly found etiological agent (57%). Blood culture was positive in 76% of cases and 82% of the patients who underwent biopsy had a spondylodiscitis diagnosis. Pain was the most prevalent clinical symptom and the lumbosacral spine was the most frequent site of infection. T1 hyposignal, T2/STIR hypersignal, and terminal plate destruction were verified in almost all MR scans. Conclusions No direct correlation was found between MR findings and any specific etiological agent. Blood culture and biopsy are important diagnostic tools that should be used for accurate diagnosis of the infectious agent . Level of evidence IV; Diagnostic Study.
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14
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Comparison of the Diagnostic Value of MRI and Whole Body 18F-FDG PET/CT in Diagnosis of Spondylodiscitis. J Clin Med 2020; 9:jcm9051581. [PMID: 32455982 PMCID: PMC7290470 DOI: 10.3390/jcm9051581] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/11/2022] Open
Abstract
Spondylodiscitis is a spine infection for which a diagnosis by a magnetic resonance imaging (MRI) is considered the most appropriate imaging technique. The aim of this study was to compare the role of an 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and an MRI in this field. For 56 patients with suspected spondylodiscitis for whom MRI and 18F-FDG PET/CT were performed, we retrospectively analyzed the results. Cohen’s κ was applied to evaluate the agreement between the two techniques in all patients and in subgroups with a different number of spinal districts analyzed by the MRI. Sensitivity, specificity, and accuracy were also evaluated. The agreements of the 18F-FDG PET/CT and MRI in the evaluation of the entire population, whole-spine MRI, and two-districts MRI were moderate (κ = 0.456, κ = 0.432, and κ = 0.429, respectively). In patients for whom one-district MRI was performed, 18F-FDG PET/CT and MRI were both positive and completely concordant (κ = 1). We also separately evaluated patients with suspected spondylodiscitis caused by Mycobacterium tuberculosis for whom the MRI and 18F-FDG PET/CT were always concordant excepting in 2 of the 18 (11%) patients. Sensitivity, specificity, and accuracy of the MRI and 18F-FDG PET/CT were 100%, 60%, 97%, and 92%, 100%, and 94%, respectively. Our results confirmed the 18F-FDG PET/CT diagnostic value in the diagnosis of spondylodiscitis is comparable to that of MRI for the entire spine evaluation. This could be considered a complementary technique or a valid alternative to MRI.
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15
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Talbott JF, Shah VN, Uzelac A, Narvid J, Dumont RA, Chin CT, Wilson DM. Imaging-Based Approach to Extradural Infections of the Spine. Semin Ultrasound CT MR 2018; 39:570-586. [PMID: 30527522 DOI: 10.1053/j.sult.2018.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jason F Talbott
- Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital, San Francisco; Department of Radiology and Biomedical Imaging, University of California, San Francisco.
| | - Vinil N Shah
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Alina Uzelac
- Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital, San Francisco; Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Jared Narvid
- Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital, San Francisco; Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Rebecca A Dumont
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Cynthia T Chin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - David M Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
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Cianfoni A, Giamundo M, Pileggi M, Huscher K, Shapiro M, Isalberti M, Kuhlen D, Scarone P. Spinal Instrumentation Rescue with Cement Augmentation. AJNR Am J Neuroradiol 2018; 39:1957-1962. [PMID: 30213804 DOI: 10.3174/ajnr.a5795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/23/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Altered biomechanics or bone fragility or both contribute to spine instrumentation failure. Although revision surgery is frequently required, minimally invasive alternatives may be feasible. We report the largest to-date series of percutaneous fluoroscopically guided vertebral cement augmentation procedures to address feasibility, safety, results and a variety of spinal instrumentation failure conditions. MATERIALS AND METHODS A consecutive series of 31 fluoroscopically guided vertebral augmentation procedures in 29 patients were performed to address screw loosening (42 screws), cage subsidence (7 cages), and fracture within (12 cases) or adjacent to (11 cases) the instrumented segment. Instrumentation failure was deemed clinically relevant when resulting in pain or jeopardizing spinal biomechanical stability. The main study end point was the rate of revision surgery avoidance; feasibility and safety were assessed by prospective recording of periprocedural technical and clinical complications; and clinical effect was measured at 1 month with the Patient Global Impression of Change score. RESULTS All except 1 procedure was technically feasible. No periprocedural complications occurred. Clinical and radiologic follow-up was available in 28 patients (median, 16 months) and 30 procedures. Revision surgery was avoided in 23/28 (82%) patients, and a global clinical benefit (Patient Global Impression of Change, 5-7) was reported in 26/30 (87%) cases at 1-month follow-up, while no substantial change (Patient Global Impression of Change, 4) was reported in 3/30 (10%), and worsening status (Patient Global Impression of Change, 3), in 1/30 (3%). CONCLUSIONS Our experience supports the feasibility of percutaneous vertebral augmentation in the treatment of several clinically relevant spinal instrumentation failure conditions, with excellent safety and efficacy profiles, both in avoidance of revision surgery and for pain palliation.
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Affiliation(s)
- A Cianfoni
- From the Departments of Neuroradiology (A.C., M.P., M.I.) .,Department of Neuroradiology (A.C.), Inselspital, Bern, Switzerland
| | - M Giamundo
- Neurosurgery (M.G., D.K., P.S.), Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - M Pileggi
- From the Departments of Neuroradiology (A.C., M.P., M.I.)
| | - K Huscher
- Department of Neurosurgery (K.H.), Hôpital du Valais, Sion, Switzerland
| | - M Shapiro
- Department of Radiology (M.S.), New York University Langone Medical Center, New York, New York
| | - M Isalberti
- From the Departments of Neuroradiology (A.C., M.P., M.I.)
| | - D Kuhlen
- Neurosurgery (M.G., D.K., P.S.), Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - P Scarone
- Neurosurgery (M.G., D.K., P.S.), Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
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17
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Abstract
Spondylodiscitis is an infection of the vertebral body or disc and may also involve the epidural space, posterior elements, and paraspinal soft tissues. It is a cause of morbidity and mortality, and warrants early diagnosis and prompt treatment. Diagnosis can be difficult because of nonspecific signs and symptoms. Magnetic resonance imaging is sensitive and specific and is the imaging modality of choice for spondylodiscitis. Gadolinium contrast can show the extent of soft tissue and bone phlegmon and abscess. The test is less useful for evaluating treatment response. When magnetic resonance imaging cannot be performed or is not diagnostic, radionuclide imaging is a useful alternative. Although bone scintigraphy frequently is used as a screening test, false-negative results can occur, especially in the elderly. This test is not useful for detecting soft tissue infections that accompany or mimic spondylodiscitis. Gallium-67 citrate improves the specificity of the bone scan, can detect infection earlier than the bone scan, may be more sensitive, especially in elderly patients, and identifies accompanying soft tissue infection. Performing SPECT and SPECT/CT improves accuracy. The 2- to 3-day delay between radiopharmaceutical administration and the relatively poor image quality are significant disadvantages of gallium-67. Indium-111 biotin, alone or in combination with streptavidin, accurately diagnoses spondylodiscitis; unfortunately, this agent is not widely available. Currently, 18F-FDG imaging is the radionuclide test of choice for spondylodiscitis. The procedure, which is completed in a single session, is sensitive, has a high negative predictive value, and reliably differentiates degenerative from infectious vertebral body end plate abnormalities. In comparative investigations, 18F-FDG has outperformed bone and gallium-67 imaging. Preliminary data suggest that 18F-FDG may be able to provide an objective means to measure response to treatment. Gallium-68 citrate and 99mTc-radiolabeled antimicrobial peptides have been investigated, but their role in spondylodiscitis has yet to be established.
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Affiliation(s)
- Meera Raghavan
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
| | - Elena Lazzeri
- Regional Center of Nuclear Medicine, Pisa University Hospital, Pisa, Italy
| | - Christopher J Palestro
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
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18
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Abstract
Imaging is often used to establish a diagnosis of musculoskeletal infections and evaluate the full extent and severity of disease. Imaging should always start with radiographs, which provide an important anatomic overview. MRI is the test of choice in most musculoskeletal infections because of its superior soft tissue contrast resolution and high sensitivity for pathologic edema. However, MRI is not always possible. Alternative imaging modalities including ultrasound scan, computed tomography, and radionuclide imaging may be used. This article reviews the individual imaging modalities and discusses how specific musculoskeletal infections should be approached from an imaging perspective.
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Affiliation(s)
- Claus S Simpfendorfer
- Section of Musculoskeletal Radiology, Imaging Institute, Cleveland Clinic, CCLCM/CWRU, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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