Whole spine MRI should be recommended for pyogenic spondylodiscitis; response to Abbara et al.

Siam, Ahmed Ezzat

doi:10.1016/j.jinf.2016.03.001

Cited by 5 publications

(10 citation statements)

References 2 publications

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“…While 100% of the patients with multifocal infections had lumbar involvement, 59% of the lumbar spinal infections were unifocal. Although there are relatively few studies on multifocal spinal infection, [17][18][19] previous authors have suggested that multifocal spinal infections are likely underreported and increasing in frequency. 12 In our study, the clinical characteristics of the multifocal and unifocal infection groups were not significantly different except for cervical and thoracic involvement (spinal region).…”

Section: Discussionmentioning

confidence: 99%

“…Another study of 1,138 consecutive cases of spondylitis over 16 years reported that nearly 7% of cases were noncontiguous multifocal infections in otherwise clinically silent disease. 17,19 The authors recommended pan-spine MRIs to detect multifocal infection regardless of patient symptomatology. This study demonstrated the importance of identifying clinically silent levels, especially before surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

“…15 To date, relatively few studies have investigated the predictors of multifocal spinal infection. Previous studies have cited risk factors for spinal infection [4][5][6][7]16 and multifocal infections, [17][18][19] but none have identified specific risk factors for multifocal versus unifocal infections. The purpose of this study is to describe significant risk factors for multifocal spinal infection.…”

Section: Introductionmentioning

confidence: 99%

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High Prevalence of Multifocal Spine Infections Involving the Cervical and Thoracic Regions: A Case for Imaging the Entire Spine

Balcescu¹,

Odeh²,

Rosinski

et al. 2019

Neurospine

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Objective: Pyogenic spinal infections account for 2%-4% of orthopaedic infections. They are often difficult to diagnose, resulting in a delay in diagnosis. Risk factors for orthopaedic and spinal infection are well-documented in the literature, yet there is a paucity of studies examining risk factors specifically for multifocal spinal infections. The objective of this study was to identify predictors of multifocal spinal infections in comparison to unifocal spinal infections. Methods: The medical records, imaging studies, and bacteriology data of 20 patients treated surgically for pyogenic spinal infection over 6 years at a tertiary referral center were reviewed and analyzed after receiving Institutional Review Board approval. Univariate and multivariate analyses were performed to identify factors associated with a multifocal spinal infection. Results: Seven patients (35%) had multifocal infections. Three were bifocal, and 4 were trifocal. Patients with surgically treated cervical or thoracic spinal infections had a high rate of concomitant multifocal spinal infections (71% and 83%, respectively). Other potential predictors (e.g. , patient age, body mass index, magnetic resonance image findings, etc.) did not reach statistical significance. Each of the multifocal infections involved the lumbar spine. Conclusion: In this study, the spinal region was the only statistically significant risk factor for multifocal infection. Patients who are diagnosed with a spinal infection that requires operative treatment should have their entire spine evaluated with magnetic resonance imaging to detect multifocal involvement promptly.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High Prevalence of Multifocal Spine Infections Involving the Cervical and Thoracic Regions: A Case for Imaging the Entire Spine

Balcescu¹,

Odeh²,

Rosinski

et al. 2019

Neurospine

View full text Add to dashboard Cite

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“…In response to this study, Siam et al discussed the study population of Abbara, and pointed out that, the study size of 19 cases of unspeci c SpD is too small and noted that it was not reported whether the patients had had a total spine MRI. As a result, Siam et al recommend a whole spine MRI be performed for all patients with SpD (7).…”

Section: Discussionmentioning

confidence: 99%

“…The Pola classi cation considers these MRI morphological aspects of SpD as well as a possible neurological de cit and is thus a possible grading system for the severity of SpD (6). In the case of tuberculous SpD, the entire spinal column should be imaged during diagnosis since additional silent foci are often present (7). In contrast, literature regarding the widening of MRI imaging, from local to total spine imaging, in cases of pyogenic SpD is controversial.…”

Section: Introductionmentioning

confidence: 99%

Total Spine Magnetic Resonance Imaging for Detection of Multifocal Infection in Pyogenic Spondylodiscitis: A Retrospective Observational Study

Henkelmann

Denecke

Pieroh

et al. 2020

Preprint

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Background:Due to the unspecific symptoms of spondylodiscitis (SpD), an early radiological examination is necessary. However, controversially discussed is the need for an magnetic resonance imaging of the entire spine to exclude multisegmental infections and to determine the required surgical interventions. The aims of this study were to assess the incidence of multilevel non-contiguous pyogenic SpD and compare comorbidities, pain symptoms, and subsequent surgical strategies between unifocal (uSpD) and multifocal (mSpD) SpD. Methods:We retrospectively evaluated the data of patients with confirmed, surgically treated, pyogenic SpD who had received a total spine MRI in a single spine center between 2016 and 2018. MRI findings were classified according to Pola-classification and demographics, duration of clinical symptoms (pain and neurology) and Charlson Comorbidity-Index (CCI) results were compared between uSpD und mSpD groups. Surgical therapy was evaluated in patients with mSpD. Results: uSpD was detected by MRI in 69 of 79 patients (87 %). Of these, mSpD was detected in 10 patients (13%) with 21 infected segments (cervical and/ or thoracic and/ or lumbar region). Age and CCI were similar between uSpD and mSpD and 24 of all SpD regions were clinically unapparent. All patients with uSpD were treated operatively. In seven patients with mSpD, all infected levels of the spine were treated surgically in a one-stage procedure; one patient had a two-stage procedure and one patient had surgery at the lumbar spine, and an additional infected segment of the upper thoracic spine was treated conservatively. One patient died before a planned two-stage procedure was performed. Conclusions:Due to mSpD being found in approximately 13% of SpD cases, and considering the risk of overlooking an mSpD case, MRI imaging of the total spine is recommended. The detection of multiple infection levels can have an impact on the therapeutic strategy chosen.

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Total spine magnetic resonance imaging for detection of multifocal infection in pyogenic spondylodiscitis: a retrospective observational study

Henkelmann

Denecke

Pieroh

et al. 2021

BMC Musculoskelet Disord

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Background Due to the unspecific symptoms of spondylodiscitis (SpD), an early radiological examination is necessary. However, controversially discussed is the need for magnetic resonance imaging of the entire spine to exclude multisegmental infections and to determine the required surgical interventions. The aims of this study were to assess the incidence of multilevel non-contiguous pyogenic SpD and compare comorbidities, pain symptoms, and subsequent surgical strategies between unifocal (uSpD) and multifocal (mSpD) SpD. Methods We retrospectively evaluated the data of patients with confirmed, surgically treated, pyogenic SpD who had received a total spine MRI in a single spine center between 2016 and 2018. MRI findings were classified according to Pola-classification and demographics, duration of clinical symptoms (pain and neurology) and Charlson Comorbidity-Index (CCI) results were compared between uSpD und mSpD groups. Surgical therapy was evaluated in patients with mSpD. Results uSpD was detected by MRI in 69 of 79 patients (87%). Of these, mSpD was detected in 10 patients (13%) with 21 infected segments (cervical and/ or thoracic and/ or lumbar region). Age and CCI were similar between uSpD and mSpD and 24 of all SpD regions were clinically unapparent. All patients with uSpD were treated operatively. In seven patients with mSpD, all infected levels of the spine were treated surgically in a one-stage procedure; one patient had a two-stage procedure and one patient had surgery at the lumbar spine, and an additional infected segment of the upper thoracic spine was treated conservatively. One patient died before a planned two-stage procedure was performed. Conclusions Due to mSpD being found in approximately 13% of SpD cases, and considering the risk of overlooking an mSpD case, MRI imaging of the total spine is recommended. The detection of multiple infection levels can have an impact on the therapeutic strategy chosen.

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Whole spine MRI should be recommended for pyogenic spondylodiscitis; response to Abbara et al.

Cited by 5 publications

References 2 publications

High Prevalence of Multifocal Spine Infections Involving the Cervical and Thoracic Regions: A Case for Imaging the Entire Spine

High Prevalence of Multifocal Spine Infections Involving the Cervical and Thoracic Regions: A Case for Imaging the Entire Spine

Total Spine Magnetic Resonance Imaging for Detection of Multifocal Infection in Pyogenic Spondylodiscitis: A Retrospective Observational Study

Total spine magnetic resonance imaging for detection of multifocal infection in pyogenic spondylodiscitis: a retrospective observational study

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