Clinico-Radio-Histopathological Correlation by C-Arm Image-Guided Biopsy in Spinal Tuberculosis

Guha, Mayukh; Lal, Hitesh; Boruah, Tankeswar; Kumar, Sandeep; Sareen, Atul; Patralekh, Mohit Kumar; Kumar, Ramesh; Khanna, Geetika

doi:10.1007/s43465-021-00361-1

Cited by 5 publications

(6 citation statements)

References 18 publications

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“…This has been used in previous studies, 19,29 and we believe that it is preferable to using only the clinician's opinion or histological report as the benchmark, as other studies have done. 26,30 Consistent with the endemic nature of TB in our country, tuberculous spondylodiscitis was much more common than other diagnoses (250/284 patients; 88%). Despite the strict inclusion criteria, six patients were found to have a histologically proven, noninfectious, condition-mimicking infectious spondylodiscitis.…”

Section: Discussionsupporting

confidence: 70%

“…Granulomatous inflammation on histological examination (58/91 patients; 63.74%) was the most common diagnostic feature, while acid fast bacillus smear and culture fared poorly as diagnostic tools. More recently, Guha et al 30 reported a sensitivity of 76% and specificity of 76% for Xpert MTB/RIF assay, considering histology as the gold standard in 92 patients who underwent fluoroscopy-guided biopsy for spinal TB.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic yield of image-guided biopsy in patients with suspected infectious spondylodiscitis

Kafle

Garg

Mehta

et al. 2022

The Bone & Joint Journal

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Aims The aims of this study were to determine the diagnostic yield of image-guided biopsy in providing a final diagnosis in patients with suspected infectious spondylodiscitis, to report the diagnostic accuracy of various microbiological tests and histological examinations in these patients, and to report the epidemiology of infectious spondylodiscitis from a country where tuberculosis (TB) is endemic, including the incidence of drug-resistant TB. Methods A total of 284 patients with clinically and radiologically suspected infectious spondylodiscitis were prospectively recruited into the study. Image-guided biopsy of the vertebral lesion was performed and specimens were sent for various microbiological tests and histological examinations. The final diagnosis was determined using a composite reference standard based on clinical, radiological, serological, microbiological, and histological findings. The overall diagnostic yield of the biopsy, and that for each test, was calculated in light of the final diagnosis. Results The final diagnosis was tuberculous spondylodiscitis in 250 patients (88%) and pyogenic spondylodiscitis in 22 (7.8%). Six (2.1%) had a noninfectious condition-mimicking infectious spondylodiscitis, and six (2.1%) had no definite diagnosis and improved without specific treatment. The diagnosis was made by image-guided biopsy in 152 patients (56%) with infectious spondylodiscitis. Biopsy was contributory in identifying 132/250 patients (53%) with tuberculous spondylodiscitis, and 20/22 patients (91%) with pyogenic spondylodiscitis. Histological examination was the most sensitive diagnostic modality, followed by Xpert MTB/RIF assay. Conclusion Image-guided biopsy has a reasonably high diagnostic yield in patients with suspected infectious spondylodiscitis. A combination of histological examination, Xpert MTB/RIF assay, bacterial culture, and sensitivity provides high diagnostic accuracy in a country in which TB is endemic. Cite this article: Bone Joint J 2022;104-B(1):120–126.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Diagnostic yield of image-guided biopsy in patients with suspected infectious spondylodiscitis

Kafle

Garg

Mehta

et al. 2022

The Bone & Joint Journal

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“…There were similar findings reported in a study by Tanaka et al in 2021 [16]. However, the same method can be applied using 2D fluoroscopy without navigation [17,18]. Oblique "scotty dog" view can be used by novice surgeons and routine AP can be also used by experienced surgeons.…”

Section: Discussionsupporting

confidence: 78%

Transpedicular vertebral biopsy under O-arm navigation: a technical note

et al. 2022

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Background Despite emerging techniques, sample inadequacy remains the most important factor that necessitates need for repeat biopsy. Transpedicular Biopsy has diagnostic accuracy ranging from 75 to 90% in both computed tomography guided or percutaneous C-arm guided biopsy. Presenting in this article is an add on technique as a modification to enhance quality and quantity of sample obtained using a self designed trocar cannula with computed tomography-based Navigation. Main body We have used transpedicular biopsy technique under C Arm fluoroscopy, previously, where we used a self-designed trocar and cannula in our study of 71 cases & reported an accuracy of 88.7% with no reported complications. This is add on modification of same technique where under 3D navigation, we introduce a pituitary forceps through a correctly positioned cannula. This helps for biopsy of soft lesions/ discal level pathologies. Also, multi-planar adjustment of cannula after initial Stealth O-Arm navigation helps in sampling of different regions of vertebral body by reinsertion of pituitary forceps with simple manipulation of cannula without withdrawal. This minimizes risk of fracturing pedicle. With our technical modification, cannulated drill bit with core opening can be drilled through cannula to retrieve a sample. Our technique has limitations being experience driven and also enabling technology dependent. However, same method can be applied using 2-dimensional fluoroscopy without navigation. Conclusion Our technique of using pituitary forceps through cannula is highly effective in getting adequate representative sample with spectrum ranging from hard sclerotic lesions to soft lesions and discal pathologies. This procedure can be used with traditional 2-dimensional fluoroscopy as well as with 3-dimensional navigated precision.

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“…Percutaneous puncture biopsy is a fairly accurate, safe, and rapid diagnostic tool. 75 When the lesion is restricted to the vertebrae, as seen in noncontiguous spinal tuberculosis, percutaneous puncture biopsy has considerable advantages over open biopsy. For the obtained specimens, microbiological detection via PCR and histological staining should be performed.…”

Section: Imaging Examinationmentioning

confidence: 99%

“…Often, this can be acquired from either a percutaneous puncture biopsy or an intraoperative open biopsy. Percutaneous puncture biopsy is a fairly accurate, safe, and rapid diagnostic tool 75 . When the lesion is restricted to the vertebrae, as seen in noncontiguous spinal tuberculosis, percutaneous puncture biopsy has considerable advantages over open biopsy.…”

Section: Diagnosismentioning

confidence: 99%

Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions

Lyu

Zhang

2023

Orthopaedic Surgery

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Spinal tuberculosis, also known as Pott's disease or tuberculous spondylitis, is usually secondary to primary infection in the lungs or other systems, and in most instances, is thought to be transmitted via blood. Typical manifestations of infection include narrowing of the intervertebral disc by erosion and bone destruction of adjacent vertebrae. Atypical spinal tuberculosis is a specific type of spinal tuberculosis. It mainly consists of single vertebral lesions, single posterior structure lesions, multiple vertebral lesions, and intra-spinal lesions. Skipped multifocal spinal tuberculosis is one of these types and is characterized by two or more vertebral lesions without the involvement of the adjoining intervertebral discs, regardless of their location. To date, only a few cases have been reported. Upon clinical admission, it can be treated conservatively or surgically, depending on the patient's symptoms. In addition, gene or biological therapies are being investigated. However, because of the exceptional imaging findings and insidious symptoms, it is often misdiagnosed as a neoplastic lesion, osteoporotic fracture, or other infectious spondylitis, increasing the risk of neurological deficit and kyphotic deformity, and delaying the optimal treatment window. In this study, we review the diagnosis and treatment strategies for skipped multifocal spinal tuberculosis lesions and enumerate the common differential diagnoses, to provide reference and guidance for clinical treatment and diagnosis direction.

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Clinico-Radio-Histopathological Correlation by C-Arm Image-Guided Biopsy in Spinal Tuberculosis

Cited by 5 publications

References 18 publications

Diagnostic yield of image-guided biopsy in patients with suspected infectious spondylodiscitis

Diagnostic yield of image-guided biopsy in patients with suspected infectious spondylodiscitis

Transpedicular vertebral biopsy under O-arm navigation: a technical note

Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions

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