Identifying Pathogens of Spondylodiscitis: Percutaneous Endoscopy or CT-guided Biopsy

Ercan

et al. 2014

J Infect Dev Ctries

Introduction: Spondylodiscitis (SD) is an uncommon but important infection. The aim of this work was to study the risk factors, bacteriological features, clinical, laboratory and radiological findings of SD, and to shed light on the initial treatment. Methodology: A total of 107 patients who underwent treatment for SD were evaluated. The diagnosis of SD was defined by clinical findings, complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum tube agglutination (STA) test, Ziehl-Neelsen staining, culture, histopathology, and radiological methods such as magnetic resonance imaging (MRI) and computed tomography (CT) scans. Results: Of the 107 cases, ranging between 17 to 83 years of age, 64 (59.8%) were male. Twenty-seven (25.2%) patients had diabetes mellitus. Laboratory investigations revealed elevated CRP in 70 (65%) patients, elevated ESR in 65 (61%) patients, and elevated white blood cell (WBC) counts in 41 (38.3%) patients. Thirty-six (33.6%) patients were identified as having brucellar SD, and 5 (4.7%) patients were identified as having tuberculous SD. A total of 66 (61.6%) patients were determined to have pyogenic SD. The most frequently isolated microorganism was Staphylococcus aureus. Antibiotic therapy was given intravenously to all pyogenic SD patients. Conclusions: The incidence of SD has increased as a result of the higher life expectancy of older patients with chronic debilitating diseases and the increase of spinal surgical procedures. In patients with low back pain, SD should be considered as a diagnosis. For effective treatment, it is important to determine the etiology of the disease.

Section: Resultssupporting

confidence: 44%

Spondylodiscitis: evaluation of patients in a tertiary hospital

Ercan

et al. 2014

J Infect Dev Ctries

“…26 However, it is well known that percutaneous intervention is safer and provides quicker results at a lower cost and with decreased morbidity. 17,24 As mentioned in the introduction, percutaneous vertebral biopsies were described as early as 1934 by Ball, and image guidance was subsequently added in 1949.…”

Section: Discussionmentioning

confidence: 99%

“…7 Yang and coworkers compared endoscopic and percutaneous techniques for biopsy and reported a positive result in 90% (18/20 patients) using endoscopic biopsy and in 47% (15/32 patients) using percutaneous biopsy. 26 Ballah et al recently examined osteomyelitis in children and found 12 of the 26 cases to be positive (46%). 2 The largest and most comprehensive was a report by Sehn and Gilula who indicated that 63 of 113 cases were positive when samples were examined histologically (55.7%) and only 28 of the 92 cases positive when samples were examined microbiologically (30.4%).…”

mentioning

confidence: 99%

Computed tomography–guided percutaneous biopsy for vertebral osteomyelitis: a department's experience

Garg

Kosmas

Young

et al. 2014

FOC

Object Vertebral osteomyelitis has been reported to occur in approximately 0.2–2 cases per 100,000 annually. Elevated laboratory values such as erythrocyte sedimentation rate and C-reactive protein suggest inflammatory etiologies. Different imaging modalities, from radiography and CT scanning to nuclear medicine imaging and contrastenhanced MRI, can be employed to evaluate for osteomyelitis. Although MRI has a strong sensitivity and specificity for vertebral osteomyelitis, obtaining histological and microbiological samples remains the gold standard in diagnosis. Therapy can be geared toward the specific pathogen cultured, thereby preventing the need surgical intervention in the majority of cases. However, recent reports have questioned the percentage yield of image-guided percutaneous biopsy even when there is a high clinical suspicion for vertebral osteomyelitis. Methods After obtaining institutional review board approval, the authors performed a chart review of patients who had undergone image-guided percutaneous bone biopsies at University Hospitals Case Medical Center in Cleveland, Ohio. Data were filtered for patients in whom a biopsy sample of a vertebral body/disc was obtained. A total of 213 procedures were performed, of which clinicians indicated a concern for infection in 84, infection or neoplasm in 13, and a noninfectious etiology (the majority being neoplasms) in the remaining 116. Results Histological examination provided positive results in 25 (41.0%) of the 61 samples collected for suspected cases of osteomyelitis. Microbiology samples were less predictive, with only 16 of the 84 samples collected, or 19.0%, yielding a positive result. In 10 patients there were positive blood and/or urine cultures. Of these, 8 samples (80%) demonstrated the same pathogen identified by biopsy (for the remaining 2 positive systemic cultures, no pathogen was identified by the percutaneous intervention). In other words, half of the 16 cases that provided microbiological results from biopsy demonstrated the same results by systemic cultures. However, 89 (76.7%) of the 116 samples collected with the primary concern of neoplasm yielded results. Conclusions Image-guided percutaneous biopsy for vertebral osteomyelitis demonstrates an extremely low probability of identifying specific microbes. Blood or urine cultures concurrently identified culprit pathogens in 50% of positive biopsy cultures. Therefore, in only 8 (9.5%) of 84 biopsies did the biopsy results provide additional information to clinicians as to the pathological microorganism present and how treatment might need to be adjusted.

International Orthopaedics (SICOT)

“…Less invasive percutaneous biopsy is a safe procedure and can be taken either by guided CT-scan or by endoscopy [15]. Endoscopy also allows discectomy and drainage, and its performance for bacterial recovery is better than CT-guided spinal biopsy [68]. Whenever possible, endoscopy is nowadays the standard for taking samples as further surgical treatment may be performed.…”

Section: Biopsymentioning

confidence: 99%

“…However, currently more severe lesions are treated by LIS. Endoscopy facilitates debridement and reconstruction [68], and although CTscan percutaneous guided surgery can be used for paravertebral or intradiscal abscess drainage [50,63], bone lesions are more difficult to be treated. LIS are technically demanding but offer good results when applied early [28].…”

Section: Techniquesmentioning

confidence: 99%

Surgical treatment of spondylodiscitis. An update

Guerado

Cerván

2012

184

132

Concept Spondylodiscitis refers to an infection affecting the intervertebral disk, the vertebral body or the posterior arch of the vertebra being aetiologically, pyogenic, granulomatous (tuberculosis, brucellosis, or fungal infection) or parasitic. Diagnosis Spondylodiscitis diagnosis is based on clinical symptoms, a combination of erythrocyte sedimentation rate with C-reactive protein (CRP) tests and, less useful, leukocytosis. Blood culture is also a very cost-effective method of identifying organisms. Plain radiographs are useful, however changes may take several months to appear. Radionuclide tests are currently less used; nevertheless, fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) shows encouraging results particularly when magnetic resonance images (MRI) are unconvincing in the distinction between degenerative changes and infection. MRI with gadolinium enhancement is the choice for image diagnosis. Management Medical management is usually the basis for treatment, alone or in combination with surgery. Surgical approach, either by endoscopy or open, is indicated for biopsy when clinical evolution is unsatisfactory and no micro-organism has been isolated, and also whenever a root, spinal cord or dural compression is seen on MRI; spinal instability or severe deformity are also clear indications for surgical treatment. Less invasive surgery either CT-scan guided or, particularly, by endoscopy has good results. However open surgery is still the standard. The anterior approach allows for anterior disc and bone debridement. The posterior approach is indicated when posterior elements are involved or in the presence of an epidural abscess. Although good results have been claimed, the use of instrumentation in the presence of an infected focus is controversial, as the use of cages or BMPs are.