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

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p></jats:sec>

CT-Guided Percutaneous Spine Biopsy in Suspected Infection or Malignancy: A Study of 214 Patients

“…In addition, the field strength varied from 1.5 T to 3 T. The moderate sensitivity and the specificity of pre-biopsy imaging in the case of suspected primary tumor or metastatic bone lesion in our study indicates that CT-guided biopsies are necessary for the management and prognosis of patients with bone lesions within the vertebral column. In the case of suspected infection, Sehn and Giliula reported a success rate for identifying a causative pathogen of 30.4 % whereas Garg et al observed a success rate of 19 % [19,20]. The reported data are comparable to the results of our study, as we could detect a causative pathogen in 25 % of the samples.…”

The Etiology of Pyogenic Vertebral Osteomyelitis and Evaluation of Biopsy Specimen Cultures in Hospitalized Patients

“…On the contrary, compared to an analysis of 14 case series concerning the clinical characteristics of patients with PVO [3], the prevalence of neurological deficits in the present study was extremely low (34% vs. 4%). The short period between the onset and diagnosis or relatively fewer number of patients with Staphylococcus aureus infection in the present study might explain the difference, as described in the past study [7], although detailed analysis is necessary.…”

Computed tomography–guided percutaneous biopsy for vertebral neoplasms: a department's experience and hybrid biopsy technique to improve yield

“…18 We suspected a similar low yield from our patient population and performed a retrospective study, which demonstrated positive microbiological cultures in only 16 of 84 (19.0%) samples. 8 This discrepancy between our low diagnostic yield for vertebral osteomyelitis and frequently quoted higher statistics encouraged our own scrutiny of prior reports. We concluded that the previously proposed higher yield of vertebral osteomyelitis biopsy was either confounded by papers using inclusion criteria that were too narrow (which artificially elevated diagnostic yield) or by papers quoting statistics from other manuscripts that reported the general success of percutaneous spinal biopsy (without accounting for variable success between different pathologies).…”

“…8 Although there was no statistical difference in the biopsy approach (i.e., transpedicular, paraspinal, and so on), the use of a coaxial bone biopsy system to cut an intact osseous cortex prior to coaxial needle biopsy of lytic lesions minimized crush artifact and demonstrated 100.0% yield and sensitivity.…”

“…We ascertained the low diagnostic yield of imageguided spinal biopsy for osteomyelitis, with only 19.0% of the cases showing positive results on microbiological cultures; these findings were published in Neurosurgical Focus in 2014. 8 After our prior study, 9 additional vertebral bone biopsies were performed between October 2013 and May 2014; in total, 126 percutaneous vertebral biopsies were performed with the clinician's primary suspicion for neoplastic involvement. Those patients with a suspected lesion but without a clear clinical suspicion for neoplasm were not included in the current study.…”