Infectious and Inflammatory Processes of the Spine

A case of Winkia neuii (Actinomyces neuii) vertebral osteomyelitis and review of the literature

This case report presents an unusual occurrence of Winkia (Actinomyces) neuii vertebral osteomyelitis in a 55-year-old male patient with diabetes mellitus. W. neuii is a distinct species formerly placed within the Actinomyces genus, exhibiting unique morphological and clinical characteristics. Vertebral osteomyelitis caused by Actinomyces species is rare, with only one prior case reported in the literature. The patient was successfully managed with a combination of intravenous ceftriaxone during hospitalization and an oral antibiotic regimen for an extended period. This case report contributes to the limited body of knowledge surrounding W. neuii, as well as actinomycotic vertebral osteomyelitis.

The advancement of MRI in differentiating Modic type I degenerative changes from early spinal infections

MRI is the most sensitive and specific imaging method for the detection of advanced spinal infections. However, the differential diagnosis of early spinal infection and Modic Type I degenerative changes based on conventional MRI is difficult clinically, as they both may mimic each other by showing hypointensity on T1 weighted images and hyperintensity on T2 weighted spine MRI images. This review summarizes recent advancements in MRI, which may be useful in discriminating degenerative Modic Type I endplate changes from early spinal infection, and evaluates the diagnostic accuracy and limitations of MRI. We aim to provide indications for early differential diagnosis to help initiate appropriate treatment in a timely manner so that associated complications can be avoided.

Spinal Tumors and Tumor-like Masses: Relevance of Initial Imaging, Karnofsky Performance Status, Age, Location, and Cord Edema

Objective:

The aim of this study is to know the relevance of initial imaging, Karnofsky performance status,age,location and cord edema for future score development for radiologists.

Methods:

The present study was carried out on total of 32 patients who visited SRN Hospital and Kriti scanning centre between August 2009 to February 2019. General and systemic examination was done. Finally KPS score was given to each patient in accordance with their clinical status. Magnetic resonance imaging was contemplated using scanner – Magnetom SP Vision; Siemens –Supercon 1.0 Tesla system.

Results:

The morphologic characterization and specific assessment of various tumors and tumor like masses of spine in view of MR imaging features and their relationship with clinical features have been analyzed with Chi square test which reveal: Age versus location – χ² = 4.32; df = 4; P > 0.36 (NS), age versus cord edema – χ² = 4.27; df = 3; P > 0.23 (NS), and location versus cord edema – χ² = 2.67; df = 2; P > 0.26 (NS). Chi Square test shows there is no any statistically significant association between age and location; age and spinal cord edema, and location and spinal cord edema. Correlation between clinical aggressiveness (change in follow-up KPS) and MR imaging features could not be assessed in our study because majority of patients could not be evaluated after one month because of loss of follow-up.

Conclusion:

Poor KPS itself lead to movement during MRI and movement related artifacts affecting initial imaging,which was managed by cotton padded neck strap. KPS depends only on general condition one of the factor for outcome so for future score development age,location and cord edema together may be useful.

Diagnosis and Management of Intraspinal Tuberculoma with Giant Paraspinal Abscesses

BACKGROUND

Although tuberculosis is rare in the west, in recent years, it's becoming more and more common in China. Intraspinal tuberculoma is extremely rare, but it's an important cause of morbidity. Magnetic resonance imaging scanning is an effective method for the diagnosis of intraspinal tuberculoma.

CASE DESCRIPTION

This case report shows an intraspinal tuberculoma with giant paraspinal abscesses in a 28-year-old female patient with subacute progressing neurologic deficit. L1-L5 laminectomy was performed, followed by extensively excision of intraspinal and paraspinal lesion. Antituberculous treatment was carried out after pathologic diagnosis. An excellent clinical outcome was obtained. Within 24 hours of the surgical procedure, muscle weakness in both lower extremities started to improve. Three days later, the patient felt muscle strength recovered significantly, with grade 4/5 in the lower limbs in 2 weeks. Six weeks later, the patient was able to walk without assistance.

CONCLUSIONS

The case was treated by surgical excision of an intraspinal and a paraspinal lesion followed by normal quadruple antituberculous therapy. Although intraspinal tuberculoma is a rare entity, it can be effectively diagnosed on the basis of magnetic resonance imaging scanning and treated by the combination of medical and surgical treatments.

The role of histology in the diagnosis of spondylodiscitis

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.

[Modern radiological diagnostics in spine surgery]

BACKGROUND

Radiological imaging is important in the preoperative diagnosis of many forms of spinal pathology and plays a fundamental role in the assessment of p.o. effects, which can be verified on the spinal column as well as on the surrounding soft tissues, depending on the imaging method used.

AIM

The article provides an overview of the current status and possibilities of radiological diagnostic methods for the verification of possibly recommended spine surgery in the context of degenerative, inflammatory-infectious, post-traumatic or p.o. pathologies and changes in the spine: X‑rays, computed tomography (CT), magnetic resonance imaging (MRI). The supplementary nuclear medicine procedures (scintigraphy, PET[-CT], SPECT, etc.) which may be required for special questions are not discussed.

MATERIAL AND METHODS

The merits and limitations of the techniques used in the investigation of advanced degenerative spinal pathologies and post-traumatic conditions are discussed, with multidetector CT being the focus of attention in spinal clearance for traumatic injuries. In most cases of spinal infection, MRI images, as a central diagnostic tool, show typical findings such as destruction of adjacent endplates, bone marrow and intervertebral disc abnormalities, and paravertebral or epidural abscesses. However, it is not always easy to diagnose a spinal infection, especially if atypical MR patterns of infectious spondylitis are present. Knowledge of them means misdiagnosis and improper treatment can be avoided.

RESULTS

It is shown that high-quality modern radiological examinations are essential for diagnosis and p.o. management, as these provide answers to the main questions in the treatment: Is the entity/injury stable or unstable, acute or old, benign or malign; is there a myelopathy or p.o. complication?

DISCUSSION

The main indications for p.o. diagnostic imaging, difficulties such as metal artefact formation, and potential pitfalls are analyzed. Entity-specific radiological image patterns, imaging algorithms and differential diagnostic peculiarities are presented and discussed based on current literature and selected case studies.