Early Imaging and Course-of-Disease Control Markers of Pyogenic Vertebral Osteomyelitis

Abstract

Background. The diagnosis of early pyogenic vertebral osteomyelitis is essential for prompt determination of treatment strategy and prevention of suppurative-destructive complications, although the nonspecifi c clinical manifestation obstructs timely disease detection. Aim. To analyse the clinical accuracy of various radiological imaging methods for early detection and control over vertebral osteomyelitis course Materials and methods. A retrospective study of standardized clinical data of patients (N = 54) who underwent treatment at the Neurosurgery Department of the MМCC WR between 2010 and 2020 was carried out. Patients were observed for 12–36 months. Study fi ndings and discussion. Our study revealed that during radiological imaging, infl ammatory changes in the vertebrae specifi c to osteomyelitis were not found in any case, which signifi cantly delays the diagnosis. The study analysed and grouped radiological signs of the infl ammatory process spread in the vertebrae in case of spondylodiscitis by CT and MR stages. Spondylodiscitis was diagnosed by CT of the spine in the late third stage only in 29.0 % of patients. Nonspecifi c destructive changes of vertebrae were detected in 51.6% of persons, which required additional MRI examination to establish the diagnosis. In 19.4% of those examined in the presence of the fi rst MR stage, no specifi c CT signs of osteomyelitis were found. MRI scan of the spine is the main specifi c (93 %), accurate (94 %) and sensitive (97 %) method for early detection of pyogenic osteomyelitis. Although according to the world literature, MRI is not sensitive enough to assess the dynamics of the infl ammatory process in the spine, the progressive increase in signal intensity of vertebral cortex on T1-weighted images within aff ected vertebrae correlates well with infl ammation resolving and C-reactive protein (CRP) level normalization. We described this radiological sign as a «vertebral rim» phenomenon (VRP). In our study, a reliable correlation was found between CRP level and the «vertebral rim» phenomenon on MRI. Conclusions. For early detection of pyogenic vertebral osteomyelitis, MRI examination is the main specifi c and sensitive method. We suggest combining the CRP level and «vertebral rim» sign in practice as dynamics of spondylodiscitis markers and justifi cation of antibacterial therapy strategy.

Differentiation of Native Vertebral Osteomyelitis: A Comprehensive Review of Imaging Techniques and Future Applications

“…In the further course of the disease, there is a loss of disc height, progressive osteolysis, and further destruction of the subchondral endplates [ 26 ]. In the study by Frel et al, the vast majority of vertebrae involved in PS showed diffuse enhancement on T2WI imaging, compared with TS, an observation that has been confirmed in other studies [ 27 , 28 ].…”

“…With the further spread of pathogenic bacteria, involvement of paravertebral soft tissues also becomes characteristic of PS, and there is a high probability that paravertebral abscesses will not appear as well-defined areas in contrast enhancement with lumbar muscle abscesses [ 27 , 28 , 31 ]. In the study by Galhotra et al [ 27 ], the cervical spine became the most common site of involvement in PS due to the consecutive involvement of the cervical spine by retropharyngeal abscesses, skull base osteomyelitis, or dorsal cervical carbuncles, which is contrary to the finding that PS tends to involve the lumbar spine [ 26 , 32 , 33 ]. However, Lee et al [ 31 ] and Frel et al [ 24 ] found a greater tendency to involve the thoracolumbar spine in PS, and these findings suggest that the uncertainty of the lesion adds to the difficulty of distinguishing PS from TS.…”

“…Li et al [ 33 ] found that acute PS infection was more likely to show diffuse and endplate inflammatory reaction lines than was chronic BS, and the use of DWI can differentiate acute PS from chronic BS. Meanwhile, several papers pointed out that most of the affected areas of PS and TS were consistent with water signal intensity on T2WI, due to inflammation, and a few TS and PS might show mixed signals on T2WI, due to therapeutic interventions [ 26 , 27 , 39 ]. While Brucella does not involve protease activity that destroys vertebral bone and discs in comparison to purulent bacteria and M. tuberculosis,the intensity of localized inflammation due to Brucella infection is lower than that of purulent bacteria and M. tuberculosis , and the signal intensity of the infected area of BS is lower than that of water on T2WI [ 25 , 33 ].…”

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“…Крім того, його перевага над іншими методами діагностики полягає в здатності до візуалізації епідурального простору і спинного мозку. Чутливість цього методу становить 97%, специфічність 93%, діагностична точність 94% [1,14].…”

“…Відносні хірургічні показання включають неефективність консервативного лікування, нестабільність, деформацію хребта через значну деструкцію кістки [2]. Враховуючи той факт, що більшість пацієнтів можна успішно лікувати консервативними засобами, хірургічне втручання переважно спрямоване на бактеріологічну або гістологічну верифікацію спондилодисциту, що досягається, в першу чергу, мініінвазивними перкутанними методиками [1]. Висновки 1.…”