Computed Tomography–Guided Spinal Biopsy in Suspected Infective Spondylodiscitis: An Institutional Review of Its Utility

Abstract

Background Infectious spondylodiscitis is a debilitating condition and evidence-based medicine dictates confirming the diagnosis before treatment. Computed tomography–guided spinal biopsy plays a major role and hence we would like to determine its utility in current clinical practice. Purpose The purpose of this study is to determine the percentage of confirmatory positives of CT-guided spinal biopsy in patients who were clinicoradiologically diagnosed with infectious spondylitis. Material and Methods A retrospective analysis of patients who underwent CT-guided biopsy for suspected infectious spondylodiscitis from 2017 to 2021 in a tertiary medical center was done. The data were filtered and obtained from the electronic database of the institution. Results In all, 259 patients underwent CT-guided biopsy of the spine. The procedure provided confirmatory results in 149 (57.5%) biospecimens. Histopathology examination was confirmatory in 95 (36.6%) of the 241 biospecimens sent. The Mycobacteria Growth Indicator Tube (MGIT) was confirmatory in 51 (19.9%) of the 250 biospecimens sent and drug resistance was seen in 6/51 (11.7%) biospecimens. Xpert TB provided confirmatory results in 72 (27.8%) of the 254 biospecimens sent and rifampicin resistance was seen in 16/72 (22.2%) biospecimens. Bacterial culture was confirmatory in 29 (11.2%) of the 250 biospecimens sent. The complication documented in this study was 0.3%. Conclusion CT-guided spinal biopsy for suspected vertebral osteomyelitis is a safe and effective minimally invasive procedure. It demonstrates a positive yield in more than half of the patients. Knowing the outcome, the patients can be appropriately counseled prior to the procedure. CT-guided biopsy results were affected by prior administration of ATT (antitubercular therapy) in suspected tuberculous spondylitis patients.

Laboratory diagnostics for primary spinal infections in pediatric and adult populations: a narrative review

“…Usually, pyogenic infection is considered when acute neutrophilic infiltration is noted with widespread necrosis. Tuberculous vertebral infection is evoked when granuloma or caseous necrosis with chronic inflammation is noted, whereas it is considered as definitive when acid-fast bacillus bacteria is positive [ 99 ]. Many studies have shown the superiority of cytopathology over microbiological investigations in establishing the diagnostic of PSI [ 100 ], since it was demonstrated that histology could provide the diagnostic even when no specific infectious agent was isolated [ [63] , [80] , [99] , [100] , [101] ].…”

“…Tuberculous vertebral infection is evoked when granuloma or caseous necrosis with chronic inflammation is noted, whereas it is considered as definitive when acid-fast bacillus bacteria is positive [ 99 ]. Many studies have shown the superiority of cytopathology over microbiological investigations in establishing the diagnostic of PSI [ 100 ], since it was demonstrated that histology could provide the diagnostic even when no specific infectious agent was isolated [ [63] , [80] , [99] , [100] , [101] ]. Two papers reported of a sensitivity ranging between 81% and 91%, and a specificity of 100% for histologic examinations [ [100] , [101] ].…”

Letter to Editor Regarding “Computed Tomography-Guided Spinal Biopsy in Suspected Infective Spondylodiscitis: An Institutional Review of Its Utility”

“…We have read with interest the article by Ravichandran et al published in your highly valued journal, which evaluated the rate of positive computed tomography (CT)-assisted biopsy results in a large number of patients with clinically and radiologically suspected spondylodiscitis. 1 Such a study is valuable because the diagnosis is definitive when the causative organism is isolated, probable when at least one of the blood tests is consistent with the disease, and presumptive—if the typical CT and magnetic resonance imaging (MRI) features of the disease are present in the absence of any positive microbiological cultures. 2 Currently, CT-assisted biopsy is a recognized diagnostic tool that can provide isolation of the infectious pathogen, thus, allowing the initiation of adequate antibiotic therapy alone or after surgical intervention.…”

“…We cannot agree with the treatment algorithm proposed by Ravichandran et al who suggested initiation of antibiotic therapy on a regular basis and only in case of conservative treatment failure to perform surgical intervention. 1 Recently, with the advances in the pharmaceutical industry, there is widely accepted view that conservative therapy can and should be applied in cases where there is no neurological deficit, spinal deformity, and segment instability. 4 …”

“…We cannot agree with the treatment algorithm proposed by Ravichandran et al who suggested initiation of antibiotic therapy on a regular basis and only in case of conservative treatment failure to perform surgical intervention. 1 Recently, with the advances in the pharmaceutical industry, there is widely accepted view that conservative therapy can and should be applied in cases where there is no neurological deficit, spinal deformity, and segment instability. 4 In our opinion, treatment of proven or suspected spondylodiscitis should be done after careful analysis of the patient's general condition, clinical symptomatology, imaging findings and consideration of the possible complications and after patient consent for treatment.…”