The role of Magnetic Resonance Imaging (MRI) in the diagnosis of spondylodiscitis

Frank, Andreas; Trappe, A.

doi:10.1007/bf00346365

Cited by 28 publications

(22 citation statements)

References 3 publications

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“…Thus, in accordance with the statements made in the literature [5,6] the elastase assay shows a slight even if not indicative superiority to the known inflammation parameters such as ESR, leucocyte count or CRP.…”

Section: Discussionsupporting

confidence: 91%

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PMN granulocyte elastase ? An early indicator of postoperative spondylodiscitis?

Schneider¹,

Wildförster²,

Diekmann

1995

Acta neurochir

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The diagnosis of spondylodiscitis after lumbar disc surgery has been based so far on clinical abnormalities, non-specific changes in chemical laboratory parameters [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] and radiological examinations such as MRI. Such techniques do not enable any clear diagnosis to be made before the 3rd postoperative week. The PMN elastase released from stimulated polymorphonuclear granulocytes has been proved to be a good laboratory parameter by which it is possible to prognosticate bacterial and abacterial organ complications in surgical patients with a high degree of probability. Under investigation were 12 patients with spondylodiscitis out of 1162 operations on herniated lumbar discs. PMN elastase was determined on the 7th postoperative day. In patients with spondylodiscitis and a mean value of 110.5 micrograms/l, the elastase was on average higher by a factor of 2.6 as compared to 88 randomly selected control patients. Since spondylodiscitis is a rare complication, this results in a positive value of only 7%, which does not allow a reliable diagnosis of spondylodiscitis by the elastase assay. But because the negative predictive value is 100%, it is possible to exclude a postoperative spondylodiscitis already on the 7th postoperative day, if the elastase value is normal.

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Section: Discussionsupporting

confidence: 91%

“…Spondylodiscitis occurs as a complication after lumbar disc surgery with a frequency of 0.1% to 3.0% [2,6,16]. The diagnosis of this disease is firstly dependent upon documentation of the clinical picture.…”

Section: Introductionmentioning

confidence: 99%

PMN granulocyte elastase ? An early indicator of postoperative spondylodiscitis?

Schneider¹,

Wildförster²,

Diekmann

1995

Acta neurochir

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“…The key to accurate and early diagnosis is clinical suspicion. MRI has established to be the imaging modality of choice in diagnosing POD, with a reported sensitivity and specificity of more than 92% 71524. We could not identify any risk factors in the cases that underwent the index surgery in our institute.…”

Section: Discussionmentioning

confidence: 72%

Postoperative discitis following single-level lumbar discectomy: Our experience of 17 cases

Basu¹,

Ghosh²,

Malik³

et al. 2012

IJOO

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Background:The established protocols of treatment of postoperative lumbar discitis have not been validated till date. We report a retrospective analysis of a series of patients with discitis following single level lumbar discectomy. We analyzed the outcome of conservative treatment of postoperative discitis with the objective to define when and what surgery was required when the conservative treatment failed.Materials and Methods:A total of 17 cases of postoperative discitis treated from 2002 to 2009 were followed up and evaluated clinically, radiologically and by laboratory investigations. All the patients were treated initially conservatively with rest and antibiotic therapy after diagnosis and those who did not respond to conservative treatment of at least 4 weeks were treated surgically. The cases were followed up with serial C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), X-ray, computed tomography (CT) scan and magnetic resonance imaging (MRI) for at least 1 year.Results:The mean followup was 40.38 months (range 12-86 months). Four cases failed to respond to conservative therapy and were treated surgically. In three of these four cases, open debridement, transpedicular fixation and posterolateral fusion was performed, and in the fourth case percutaneous transpedicular fixation was done. In the former group, one case was diagnosed to be tubercular, in another case Staphylococcus aureus was cultured where as the third case culture was sterile. All operated patients showed evidence of interbody fusion at 1 year followup.Conclusions:Early detection and aggressive treatment are paramount in managing postoperative discitis and the majority do well with conservative treatment. Surgical management in the form of transpedicular fixation and debridement, when required, gives excellent results.

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“…Classical screening-clinical examination, the white blood cell count (WBC), erythrocyte sedimentation rate (ESR) and elevated temperature-has a high failure rate [5, 6, 8-11, 20, 22, 25]. It is known to have false positive and negative results-especially in the early postoperative days-which lead to multipragmatic and non-economical use of expensive examination techniques (e.g., MRI...), very often producing findings that still leave a firm diagnosis in doubt [2,7]. Definite proof of spondylodiscitis is provided by invasive techniques (e.g., biopsy) or late conventional x-ray tomography.…”

Section: Introductionmentioning

confidence: 98%

The C-reactive protein for detection of early infections after lumbar microdiscectomy

Meyer¹,

Schaller²,

Rohde³

et al. 1995

Acta neurochir

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The tendency for short hospitalization after lumbar microdiscectomy implies the need for early confirmation or disapproval of serious postoperative infections such as spondylodiscitis or deep wound infections. The C-reactive protein (CRP) is a well-known screening parameter for monitoring postoperative infectious complications in other fields. Our objective was to establish the diagnostic significance of CRP-in comparison with ESR and WBC-for monitoring infectious complications after lumbar microdiscectomy. Over a 15 months period we studied prospectively a homogeneous group of N = 400 patients with lumbar disc herniations who were operated on a single level for the first time. CRP, ESR and WBC values were determined in all patients pre-operatively, and on postoperative days 1 and 5. Clinical and laboratory findings were correlated and the diagnostic significance of CRP, ESR and WBC calculated. N = 385 (96%) patients had an uneventful postoperative course. N = 15 (4%) patients developed infectious complications, of which N = 6 (1.5%) were unrelated and N = 9 (2.5%) related to surgery. Evaluation of the laboratory values showed: The CRP baseline is a very individual value of no prognostic relevance. A high postaggression peak is typical and essential as a reference value for only the future time course will disclose any infection. We found 0% false negative and 4% false positive results on day 5. The sensitivity for serial CRP testing was calculated as 100% and specificity as 95.8%. ESR (sensitivity: 78.1%/specificity: 38.1%) and WBC (sensitivity: 21.4%/specificity: 76.8%) both failed to reach such distinct diagnostic significance on day 5. The C-reactive protein has thus proved to be a reliable, simple and economical screening test for infectious complications after lumbar microdiscectomy, superior to classical laboratory parameters.

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The role of Magnetic Resonance Imaging (MRI) in the diagnosis of spondylodiscitis

Cited by 28 publications

References 3 publications

PMN granulocyte elastase ? An early indicator of postoperative spondylodiscitis?

PMN granulocyte elastase ? An early indicator of postoperative spondylodiscitis?

Postoperative discitis following single-level lumbar discectomy: Our experience of 17 cases

The C-reactive protein for detection of early infections after lumbar microdiscectomy

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