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Ikenaga S, Yunaiyama D, Yasutomi M, Nakamura I, Okubo M, Saguchi T, Nakai M, Saito K. Usefulness of Percutaneous Drainage in Determining the Causative Microorganism in Patients with Spondylodiscitis: A Retrospective Cross-Sectional Study. J Belg Soc Radiol 2023; 107:51. [PMID: 37457675 PMCID: PMC10348065 DOI: 10.5334/jbsr.3127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose To determine the usefulness of CT-guided percutaneous drainage for the causative microorganism detection in patients with spondylodiscitis. Materials and Methods Data of patients who underwent CT-guided percutaneous drainage for spondylodiscitis from January 2014 to April 2022 were extracted from the radiological database of our hospital and investigated. The administration rate of antibiotics prior to blood culture and CT-guided percutaneous drainage (CTPD) were analyzed. The detection rate of microorganisms via blood culture and CT-guided percutaneous drainage were compared using the Mann-Whitney's U test with the SPSS software. Results In this study, a total of 30 (20 male and 10 female) patients were analyzed. A total of 13 patients (43%) were administered antibiotics prior to blood culture. Of them, microorganisms were detected via blood culture in only one patient (7%). A total of 25 patients (83%) were administered antibiotics prior to CTPD. Of them, the causative microorganisms in 19 patients (76%) were detected. Overall, the causative microorganism could be detected in 24 out of 26 patients (92%) via CT-guided percutaneous drainage. There was a statistical significance in the detection rate of microorganisms between blood culture and CTPD (P = 0.004) in favor of CTPD. Conclusion CT-guided percutaneous drainage showed a high positive rate of microorganism detection in patients with spondylodiscitis regardless of antibiotic administration prior to the procedure. CT-guided percutaneous drainage can be a solution for the detection of the causative microorganism in spondylodiscitis patients who received antibiotics before obtaining any culture.
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Affiliation(s)
- Shoichi Ikenaga
- Department of Radiology, Tokyo Medical University, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Daisuke Yunaiyama
- Department of Radiology, Tokyo Medical University, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Mika Yasutomi
- Department of Radiology, Tokyo Medical University, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Itaru Nakamura
- Department of Infection Prevention and Control, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Mitsuru Okubo
- Department of Radiology, Tokyo Medical University, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Toru Saguchi
- Department of Radiology, Tokyo Medical University, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Motoki Nakai
- Department of Radiology, Tokyo Medical University, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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Koike Y, Kai R, Abe R, Munechika J, Ohgiya Y. Outcomes of C-arm cone-beam CT-guided percutaneous procedures for thoracolumbar spondylodiscitis: a comparison between with and without intradiscal drainage. MINIM INVASIV THER 2023; 32:81-89. [PMID: 36780294 DOI: 10.1080/13645706.2023.2174806] [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: 02/14/2023]
Abstract
INTRODUCTION Percutaneous intradiscal drainage had little established evidence to date. We assessed the outcomes of C-arm cone-beam CT-guided (CBCT-guided) procedures for spondylodiscitis and compare procedures with and without intradiscal drainage. MATERIAL AND METHODS A retrospective review was conducted on patients who underwent CBCT-guided procedures for spondylodiscitis with fluid collection in the intradiscal space between January 2010 and September 2021. Included patients were divided into two groups: with and without 'intradiscal drainage' (ID and non-ID, respectively). RESULTS A total of 87 patients with thoracolumbar discitis (mean age 73.4 ± 12.3 years, 35 females) were included. There was no significant difference in clinical outcomes between groups. Although insignificant, a subgroup analysis of patients with discitis and psoas abscess showed a higher infection control success rate (81% (17/21) vs 58% (7/12), p = .23) and faster median C-reactive protein improvement (CRP <3 mg/dL: 12 vs 42 days, p = .11, CRP <1 mg/dL: 27 vs 45 days, p = .097) of ID than of non-ID. CONCLUSIONS Findings did not clarify the role of intradiscal drainage when it was indicated in all cases of spondylodiscitis with fluid collection. Future studies with larger sample sizes of selected discitis cases are expected to demonstrate the superiority of intradiscal drainage.
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Affiliation(s)
- Yuya Koike
- Division of Radiology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan.,Department of Interventional Radiology, Saiseikai Yokohamashi Nanbu Hospital, Kanagawa, Japan
| | - Ryozo Kai
- Division of Radiology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Ryosuke Abe
- Division of Radiology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Jiro Munechika
- Division of Radiology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Yoshimitsu Ohgiya
- Division of Radiology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan
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Barber SM, Sofoluke N, Reardon T, Telfeian A, Konakondla S. Treatment of Refractory Multilevel Thoracic Spondylodiscitis Using Ultra-Minimally Invasive Endoscopic Approach for Debridement and Drainage: A Technical Note, Intraoperative Video, and Literature Review. World Neurosurg 2022; 167:e456-e463. [PMID: 35973523 DOI: 10.1016/j.wneu.2022.08.034] [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: 07/17/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE/BACKGROUND Spondylodiscitis is an infection of the spinal column which can result in pain, deformity, instability, and/or neurologic deficits. When surgical treatment is required for thoracic spondylodiscitis, invasive open approaches are often utilized due to the ventral location of the pathology. METHODS We describe the use of a spinal endoscope to perform drainage and debridement of infected tissue through a transforaminal/intradiscal approach in a patient with multilevel thoracic spondylodiscitis refractory to antibiotic therapy. Illustrative videos are provided, as well as a review of the relevant literature. RESULTS A total of 188 patients were included in the systematic review. The mean positive reported culture rate was 76% (117/154 patients). The mean preoperative visual analog scale score was 6.8 (n = 114), and the mean postoperative visual analog scale score was 1.8 at 1 week postoperatively (n = 56) and 1.01 at the final follow-up (n = 114). The most common surgical approach was transforaminal/intradiscal (103/188 patients, 54.8%). The mean reoperation rate was 9.1%. The mean complication rate was 5.25%, with complications including increased transient radicular pain, infection, hardware failure, and new unspecified neurological deficits. CONCLUSION This case and those highlighted in our literature review demonstrate that endoscopic treatment for thoracic spondylodiscitis is a viable alternative to traditional open surgery in many cases.
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Affiliation(s)
- Sean M Barber
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas, USA.
| | - Nelson Sofoluke
- Geisinger Neuroscience Institute, Geisinger Health, Danville, Pennsylvania, USA
| | - Taylor Reardon
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, Kentucky, USA
| | - Albert Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sanjay Konakondla
- Geisinger Neuroscience Institute, Geisinger Health, Danville, Pennsylvania, USA
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Tomita K, Matsumoto T, Kamono M, Miyazaki K, Hasebe T. CT fluoroscopy-guided percutaneous intervertebral drain insertion for cervical pyogenic spondylodiscitis. Diagn Interv Radiol 2021; 27:269-271. [PMID: 33599204 DOI: 10.5152/dir.2021.20189] [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]
Abstract
A 79-year-old man was admitted to our hospital with C6-C7 pyogenic spondylodiscitis with an epidural abscess. Since the cervical intervertebral space is narrower than the thoracolumbar intervertebral space, drain insertion into the cervical intervertebral space requires a more accurate procedure. Moreover, the specific anatomy of cervical vertebrae, which includes the transverse foramen through which the vertebral artery passes and the uncinate process on the side edges of the top surface of the bodies, makes it impossible to perform computed tomography (CT)-guided percutaneous intervertebral drain insertion through the posterolateral approach. Therefore, CT fluoroscopy-guided percutaneous cervical intervertebral drain insertion using a lateral approach, in which the needle is advanced between the carotid sheath and scalene muscle, and simultaneous intravenous contrast enhancement might be a safe and useful technique. There have been no papers on CT fluoroscopy-guided percutaneous intervertebral drain insertion for cervical pyogenic spondylodiscitis, while successful CT fluoroscopy-guided percutaneous intervertebral drain insertion for thoracolumbar pyogenic spondylodiscitis has been reported. Here, we successfully performed CT fluoroscopy-guided percutaneous intervertebral drain insertion for cervical pyogenic spondylodiscitis.
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Affiliation(s)
- Kosuke Tomita
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Hachioji, Tokyo, Japan
| | - Tomohiro Matsumoto
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Hachioji, Tokyo, Japan
| | - Masahiro Kamono
- Department of General Internal Medicine, Tokai University Hospital, Tokai University School of Medicine, Shimo Kasuya, Isehara-shi, Kanagawa, Japan
| | - Koji Miyazaki
- Department of General Internal Medicine, Tokai University Hachioji Hospital, Tokai University School of Medicine, Ishikawa-machi, Hachioji, Tokyo, Japan
| | - Terumitsu Hasebe
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Hachioji, Tokyo, Japan
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