No abstract

Methods A single institution retrospective chart review identified 78 patients undergoing 84 percutaneous aspiration/ biopsy procedures for vertebral osteomyelitis/discitis over five years. A multivariate model was used to create a risk stratification scale to predict technically successful biopsies. The clinical course of the 63 patients referred to the infectious disease department were then analyzed for changes in management.Results Multivariate analysis demonstrated that C-reactive protein > 1.5 and a percutaneously drainable collection were significantly associated with technically successful biopsy. A three point scale was created; the presence of zero, one, or both factors predicted a technically successful biopsy rate of 10%, 30%, and 70%, respectively. Of the subset of patients referred to the infectious disease department, 41% of biopsies were technically successful but only 17% lead to changes in management. Importantly, patients in the highest group were likely to be diagnosed by other means (blood cultures, urine cultures, etc) and therefore did not lead to independent changes in management. For each biopsy that lead to a management change, a total of six patients would wait a combined total of 23 hospital days. Additionally, biopsies performed >10 days from admission did not lead to changes in management. Conclusion A two-factor score, consisting of C-reactive protein > 1.5 and the presence of a drainable fluid collection, can be used to predict the technical success of biopsies on patients with vertebral osteomyelitis/discitis. However, the results of such biopsies commonly do not change clinical management, and are associated with patient and health care costs. Careful discussion with infectious disease experts will be needed to minimize unnecessary risk for patients and to avoid procedures that may not change management.

complete resolution of symptoms following ppVAD. [The above information is detailed in Table 2]Conclusion A limited cohort of 33 ppVADs exist in the literature. This study contributes 7 additional cases and suggests that, despite heterogenous management of ppVAD, the resulting outcomes were favorable.