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Early diagnosis of sacroiliitis may lead to preventive treatment which can significantly improve the patient's quality of life in the long run. Oftentimes, a CT scan of the lower back or abdomen is acquired for suspected back pain. However, since the differences between a healthy and an inflamed sacroiliac joint in the early stages are subtle, the condition may be missed. We have developed a new automatic algorithm for the diagnosis and grading of sacroiliitis CT scans as incidental findings, for patients who underwent CT scanning as part of their lower back pain workout. The method is based on supervised machine and deep learning techniques. The input is a CT scan that includes the patient's pelvis. The output is a diagnosis for each sacroiliac joint. The algorithm consists of four steps: 1) computation of an initial region of interest (ROI) that includes the pelvic joints region using heuristics and a U-Net classifier; 2) refinement of the ROI to detect both sacroiliac joints using a four-tree random forest; 3) individual sacroiliitis grading of each sacroiliac joint in each CT slice with a custom slice CNN classifier, and; 4) sacroiliitis diagnosis and grading by combining the individual slice grades using a random forest. Experimental results on 484 sacroiliac joints yield a binary and a 3-class case classification accuracy of 91.9% and 86%, a sensitivity of 95% and 82%, and an Area-Under-the-Curve of 0.97 and 0.57, respectively. Automatic computer-based analysis of CT scans has the potential of being a useful method for the diagnosis and grading of sacroiliitis as an incidental finding.

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Background: The design is a retrospective cohort study. Charcot spinal arthropathy (CSA) is a rare and poorly understood progressive destructive spine condition that usually affects patients with preexisting spinal cord injury. The complexity of this condition, especially when additionally burdened by superimposed infection in the CSA zone, can potentially lead to suboptimal management such as protracted antibiotic therapy, predisposition to hardware failure, and pseudarthrosis. While in noninfected CSA primary stabilization is the major goal, staged surgical management has not been stratified based upon presence of a superinfected CSA. We compare clinical and radiological outcomes of surgical treatment in CSA patients with and without concurrent spinal infections.Methods: Our single-institution database was reviewed for all patients diagnosed with CSA and surgically treated, who were subsequently divided into 2 cohorts: spinal arthropathy with superimposed infection and those without. Those were comparatively studied for complications and reoperation rate.Results: Fifteen patients with CSA underwent surgical intervention; mean follow up of 15.3 months (range, 0-43). Eleven patients received stabilization with a quadruple-rod thoracolumbopelvic construct, while 4 patients with superinfected CSA underwent a staged procedure. Patients treated with a staged approach experienced fewer intraoperative complications (0% versus 18%) and fewer revision surgeries (25% versus 36%). Both cohorts had the same eventual healing.Conclusions: Surgical management in CSA patients with primary emphasis on stability and modified surgical treatment based on presence of an active infection in the zone of neuropathic destruction will lead to similar eventual successful results with relatively few and manageable complications in this challenging patient population.Level of Evidence: 4. Clinical Relevance: The proposed treatment algorithm including the use of a quadruple-rod construct with lumbopelivic fixation and a staged approach in patients with superinfected CSA represents a reasonable option in the surgical treatment of CSA.

Study Design: Retrospective case series analysis. Objective: To identify relevant clinical and radiographic markers for patients presenting with infectious spondylo-discitis associated with spinal instability directly related to the infectious process. Methods: We evaluated patients presenting with de-novo intervertebral discitis or vertebral osteomyelitis /discitis (VOD) who initiated non-surgical treatment. Patients who failed conservative treatment and required stabilization surgery within 90 days were defined as “ failed treatment group” (FTG). Patients who experienced an uneventful course served as controls and were labeled as “ nonsurgical group” (NSG). A wide array of baseline clinical and radiographic parameters was retrieved and compared between 2 groups. Results: Overall 35 patients had initiated non-surgical treatment for VOD. 25 patients had an uneventful course (NSG), while 10 patients failed conservative treatment (“FTG”) within 90 days. Factors found to be associated with poorer outcome were intra-venous drug abuse (IVDA) as well as the presence of fever upon initial presentation. Radiographically, involvement of the same-level facets and the extent of caudal and rostral VB involvement in both MRI and CT were found to be significantly associated with poorer clinical and radiographic outcome. Conclusions: We show that clinical factors such as IVDA status and fever as well as the extent of osseous and posterior element involvement may prove to be helpful in favoring surgical treatment early on in the management of spinal infections.

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