CT Fluoroscopy-Guided Transsacral Intervertebral Drainage for Pyogenic Spondylodiscitis at the Lumbosacral Junction

Matsumoto, Tomohiro; Mine, Takahiko; Hayashi, Toshihiko; Kamono, Masahiro; Taoda, Akiko; Higaki, Megumu; Hasebe, Terumitsu

doi:10.1007/s00270-016-1452-9

Cited by 6 publications

(6 citation statements)

References 11 publications

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“…In comparison to our case there are lot of similarities including abscess localization, risk of adjacent structures damage and technique of catheter positioning. As in our case, all three drainage procedures were successful, neither early nor late procedure-related complications like bleeding, nerve injury, bone fracture, osteomyelitis or bone abscess occurred [12].…”

Section: Transosseus Approachsupporting

confidence: 67%

“…In our case transosseus approach was successfully performed, and it is considered as a rare case as there are only few of them described in scientific literature. Analogical CT fluoroscopy-guided transsacral drainage technique was performed in Tokai University Hachioji hospital [12]. In three cases of pyogenic spondylodiscitis this procedure was considered as the safest and most feasible technique.…”

Section: Transosseus Approachmentioning

confidence: 99%

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Common Options and Overlooked Alternative for Drainage of Inaccessible Presacral Abscess: A Case Report

Kodzis

Jocius

Lapteva

et al. 2021

AML

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Purpose. To demonstrate options and alternative for drainage of inaccessible presacral abscess by the example of a rare clinical case of pyogenic spondylodiscitis, transsacraly drained under a combination of two interventional techniques – CT-guided bone biopsy and abscess drainage.Materials and methods. A 55-year-old patient with history of recurrent paravertebral abscesses previously treated with antibiotic therapy was referred to our institution experiencing lower back pain and weakness in both lower extremities. Computed tomography revealed pyogenic spondylodiscitis along with left facet joint destruction and presacral abscess located in ventral sacral surface. Due to inaccessible abscess location, it was decided to perform CT-guided percutaneous transsacral abscess drainage. An 8G bone marrow biopsy needle was used to penetrate the sacrum and create a path for drainage catheter placement. Using the Seldinger technique 8 Fr drainage catheter was inserted into abscess cavity.Results. Neither early nor late procedure-related complications occurred. Sixteen days after drainage procedure, the catheter was withdrawn as patient’s condition improved and the outflow of pus had reduced considerably.Conclusions. Despite being rarely used, CT fluoroscopy-guided transsacral drainage approach is considered to be minimally invasive and in some cases the only viable option for drainage of pyogenic spondilodiscitis of the lumbosacral junction.

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Section: Transosseus Approachsupporting

confidence: 67%

Section: Transosseus Approachmentioning

confidence: 99%

Common Options and Overlooked Alternative for Drainage of Inaccessible Presacral Abscess: A Case Report

Kodzis

Jocius

Lapteva

et al. 2021

AML

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“…Zur Behandlung der pyogenen Spondylodiszitis im Bereich des lumbosakralen Übergangs wurde eine CT-fluoroskopisch geführte transsakrale intervertebrale Drainage (nach vorangegangener Biopsie) mit gezielter Anwendung von Antibiotika über 6 Wochen durchgeführt. Es zeigte sich an 3 Patienten, dass die über 17-33 Tage vorgenommene Drainage zu guten Erfolgen ohne unerwünschte Ereignisse führte [118].…”

Section: Operative Behandlungenunclassified

Spondylitis – Spondylodiscitis – an Update

et al. 2018

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Spondylodiscitis is an infection of the intervertebral disc with subsequent infection of the adjacent vertebral bodies. The main causes are 3 pathogen groups: bacteria, particularly tuberculosis pathogens, fungi and parasites. In pyogenic spondylodiscitis, infections with Staphylococcus aureus are the most common, with an incidence of up to 80%. Mortality is around 2 - 3%. Infections with tuberculosis are often associated with psoas and paravertebral abscesses. Neurological deficits are registered in up to 50% of patients. For microbiological diagnostic testing, blood cultures are used for aerobic and anaerobic bacteria. However, histological examination leads significantly more frequently to positive pathogen detection. In tissue samples, results with 16S rRNA PCR results are clearly superior to results from microbiological examination. The MRI exhibits high sensitivity and specificity and is therefore superior to other radiological methods. Elimination of the infection, pain reduction and stabilisation of the spine are the main objectives of any treatment. A standardised antibiotic therapy for spondylodiscitis has not been clearly defined. Pathogen detection is important, with focused antibiotic therapy. Antibiotic therapy should initially be administered intravenously for 2 - 4 weeks. This should be followed by oral administration for 6 - 12 weeks. In the case of antibiotic-resistant infections with neurological deficiencies, it is recommended to perform a surgical procedure, with careful debridement and instrumentation as well as i. v. administered antibiotics for 3 weeks followed by three month oral antibiotic treatment. Surgical procedures are indicated with neurological deficits, progressive increase in spinal deformities, failure of conservative therapy with insufficient pain relief and unreliable pathogen identification. The selection of the surgical procedure should mainly be based on the extent and localisation of bone destruction and the individual circumstances of the patients. The prognosis is good if there is a clear reduction in CRP and ESR in the first few weeks.

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“…In addition to obtaining blood cultures, patients subsequently underwent imageguided biopsy to obtain an infected vertebrae or disc specimen for culture and pathological examination. Image-guided biopsy was performed by interventional radiologists [4].…”

Section: Journal Of Medical Microbiology and Diagnosismentioning

confidence: 99%

The Etiology of Pyogenic Vertebral Osteomyelitis and Evaluation of Biopsy Specimen Cultures in Hospitalized Patients

Kamono¹,

Kabeya²,

Sohara³

et al. 2017

J Med Microb Diagn

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Identifying the causative pathogens in patients with pyogenic vertebral osteomyelitis is important for optimizing antibiotic therapy. Thus, we examined patient characteristics and investigated the efficacy of the combined use of blood culture and image-guided biopsy culture for identifying the causative pathogens of pyogenic vertebral osteomyelitis. A case series study was conducted in hospitalized patients who were diagnosed with pyogenic vertebral osteomyelitis using electronic medical records. Twenty-three patients who had undergone both blood culture and image-guided biopsy to determine the causative pathogens were identified. Detailed patient characteristics were identified, and the detection rate of a causative pathogen was 57% using either blood or biopsy specimen culture. By combining the results of each culture, the detection rate was increased to 83%. We described the detailed characteristics of patients with pyogenic vertebral osteomyelitis from whom both blood and biopsy specimen cultures were obtained. We found that the combined use of blood culture and biopsy specimen culture is useful for enhancing the detection of causative pathogens in patients with pyogenic vertebral osteomyelitis.

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CT Fluoroscopy-Guided Transsacral Intervertebral Drainage for Pyogenic Spondylodiscitis at the Lumbosacral Junction

Abstract: CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction is feasible and can be effective with a combination of two interventional techniques-CT fluoroscopy-guided bone biopsy and abscess drainage.

Cited by 6 publications

References 11 publications

Common Options and Overlooked Alternative for Drainage of Inaccessible Presacral Abscess: A Case Report

Common Options and Overlooked Alternative for Drainage of Inaccessible Presacral Abscess: A Case Report

Spondylitis – Spondylodiscitis – an Update

The Etiology of Pyogenic Vertebral Osteomyelitis and Evaluation of Biopsy Specimen Cultures in Hospitalized Patients

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