Diagnostic Accuracy and Adequacy of Computed Tomography Versus Fluoroscopy-Guided Percutaneous Transpedicular Biopsy of Spinal Lesions

Zakaria@Mohamad, Zamzuri; Rahim, Abdullah A; Kow, Ren Yi; Karupiah, Rajandra Kumar; Abidin, Nur Azlin Zainal; Mohamad, Fazir

doi:10.7759/cureus.20889

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…The diagnostic rate of image-guided percutaneous spinal needle biopsy was reported to be 80–97.3% [ 7 , 8 , 9 , 10 , 11 , 12 ], which is consistent with the present results. Yang et al [ 8 ] reported a decreased diagnostic rate for lesions <20 mm.…”

Section: Discussionsupporting

confidence: 93%

Factors Predicting the Final Diagnosis in Image-Guided Percutaneous Needle Biopsy for Suspected Spinal Tumors

Oka¹,

Suzuki²,

Terai³

et al. 2023

JCM

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In cases of suspected spinal tumors on imaging studies, a biopsy is often necessary for establishing the diagnosis. Predictive factors for tumors or malignancies may help in scheduling biopsies or avoiding unnecessary ones. However, there have been few studies on determining these factors. We aimed to determine the factors associated with the final diagnosis in cases requiring spinal biopsy. This study included 117 patients who underwent image-guided (fluoroscopy- or computed tomography [CT]-guided) needle biopsy of the spine. Data on patient demographic, pathological diagnoses, and final diagnoses were retrospectively collected from the medical records. The imaging features and location of lesions were also evaluated on CT and magnetic resonance imaging. Furthermore, factors related to tumors or malignancies were analyzed. The diagnostic accuracy of biopsy was 94.0%, and there was no difference in the diagnostic accuracy between the fluoroscopic and CT-guided biopsies. Sixty-six and fifty-six patients were diagnosed with spinal tumors and malignant tumors, respectively. Multivariate analysis revealed that a history of malignant tumors and the presence of pedicle lesions and/or extravertebral lesions were related factors for both tumors or malignancy in the final diagnosis. These findings can help determine the necessity for or timing of biopsy in patients with suspected spinal tumors.

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Section: Discussionsupporting

confidence: 93%

Factors Predicting the Final Diagnosis in Image-Guided Percutaneous Needle Biopsy for Suspected Spinal Tumors

Oka¹,

Suzuki²,

Terai³

et al. 2023

JCM

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“…At the time of diagnosis, the average erythrocyte sedimentation rate (ESR) is approximately 60 mm/h [ 18 , 25 , 26 , 53 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ]. Among patients who underwent an uncomplicated discectomy, 97% exhibited c-reactive protein (CRP) values below 2.5 μg/mL, ESR values below 45 mm/h, temperatures equal to or below 37.5 °C, and normal magnetic resonance imaging (MRI) findings within the initial 10 days post-surgery.…”

Section: Resultsmentioning

confidence: 99%

“…Samples (disc material, subchondral bone and abscess fluid) are collected from the affected disc space as well as the surrounding inflammatory soft tissue. Fluoroscopic guide percutaneous transpedicular biopsy offers similar accuracy and adequacy and can be used in cases that CT-guided biopsy is not available [ 59 ]. In a recent systematic review aiming to determine the diagnostic culture yield of CT-guided biopsies performed in cases of suspected spinal infections, the authors reported only 33% diagnostic accuracy of CT-guided biopsies, in terms of positive cultures.…”

Section: Resultsmentioning

confidence: 99%

Post-Discectomy Infection: A Critical Review and Suggestion of a Management Algorithm

Chaniotakis,

Koutserimpas,

Tsantes

et al. 2024

JCM

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Postoperative discitis (POD) accounts for 20% to 30% of all cases of pyogenic spondylodiscitis, while POD may be mis-or-under-diagnosed, due to the vague related symptomatology and the non-specific imaging findings. Most studies report infection rate of less than 1%, which increases with the addition of non-instrumented fusion to 2.4% to 6.2%. It remains controversial whether POD is caused by an aseptic or infectious process. Positive cultures are presented only in 42–73% of patients with Staphylococcus species being the most common invading organisms, while Staphylococcus aureus is isolated in almost 50% of cases. The onset of POD symptoms usually occurs at 2–4 weeks after an apparently uneventful operation. Back pain and muscle spasms are usually refractory to bed rest and analgesics. Magnetic Resonance Imaging (MRI) is the most sensitive and specific imaging diagnostic technique. Antimicrobial therapy depends on the results of tissue cultures, and along with bracing represents the mainstay of management. Surgical intervention is necessary in patients failing conservative treatment. For the majority of cases, extensive surgical debridement, antibiotic therapy, and orthosis immobilization are effective in eliminating the infection. According to this, we recommend an Algorithmic approach for the management of POD. Postoperative infections after spinal surgery pose a certain clinical challenge, and in most cases can be treated conservatively. Nevertheless, disability may be persistent, and surgery could be necessary. The purpose of this concise review is to describe the manifestation of post-discectomy infection, its pathogenesis and particularly a rational approach for its management.

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“…Furthermore, the subsequent treatment of anti-TB medication was deemed ineffective. However, it is worth noting that the puncture biopsy under the guidance of CT is recognized as a critical method of diagnosis in cases of unknown etiology of vertebral body destruction [ 65 ]. Therefore, PMseq of specimens of the L4 vertebral lesion was performed concurrently to detect all possible pathogens.…”

Section: Discussionmentioning

confidence: 99%

Malassezia restricta as an unexpected cause of infectious osteomyelitis diagnosed by metagenomic sequencing: a case report and literature review

Peng,

Lin,

Zou

et al. 2024

BMC Infect Dis

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Background Malassezia restricta, a lipophilic and lipodependent yeast belonging to the basidiomycetes group, is an opportunistic fungal pathogen associated with various skin diseases, including seborrheic dermatitis and dandruff. Typically, Malassezia infection in neonates manifests as fungemia or hematogenous dissemination to the bone or lungs. However, vertebral osteomyelitis caused by these fungi is rarely reported owing to non-specific clinical presentations and laboratory/imaging findings. The Pathogen Metagenomics Sequencing (PMseq) technique enables direct high-throughput sequencing of infected specimens, facilitating the rapid and accurate detection of all microorganisms in clinical samples through comprehensive reports. Case presentation A 52-year-old male was admitted to our hospital on July 20, 2022 with a 3-month history of ambulatory difficulties and localized low back pain. Magnetic Resonance Imaging (MRI) examination of the spinal column revealed irregular bone destruction affecting the L2, L3, and L5 vertebral bodies. Additionally, low T1 and high T2 intensity lesions were observed at the intervertebral discs between L3 and L5. The presumptive diagnosis of tuberculous spondylitis was made based on the imaging findings, despite negative results in all mycobacterium tests. However, the patient exhibited no improvement after receiving regular anti-tuberculosis treatment for 3 months. Subsequent MRI revealed an expansive abnormal signal within the vertebral body, leading to progressive bone destruction. The absence of spinal tuberculosis or other infective microorganisms was confirmed through culture from blood and pathological tissue from the L4 vertebral body. Subsequently, PMseq was performed on the specimens, revealing M. restricta as the predominant pathogen with the highest relative abundance value. The pathological examination revealed the presence of fungal mycelium in the L4 vertebral body, with positive findings on periodic Schiff-methenamine and periodic acid-Schiff staining. The anti-tuberculosis treatment was discontinued, and an antifungal combination of fluconazole and voriconazole was administered. All symptoms were resolved after 7 consecutive months of treatment, and the patient was able to ambulate autonomously. Vertebral lesions were reduced on MRI during the 13-month follow-up. Conclusions M. restricta is not a commonly recognized pathogen associated with infectious vertebral osteomyelitis. However, PMseq can aid in diagnosis, timely treatment, and decision making for some non-specific infectious diseases.

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Diagnostic Accuracy and Adequacy of Computed Tomography Versus Fluoroscopy-Guided Percutaneous Transpedicular Biopsy of Spinal Lesions

Cited by 3 publications

References 19 publications

Factors Predicting the Final Diagnosis in Image-Guided Percutaneous Needle Biopsy for Suspected Spinal Tumors

Factors Predicting the Final Diagnosis in Image-Guided Percutaneous Needle Biopsy for Suspected Spinal Tumors

Post-Discectomy Infection: A Critical Review and Suggestion of a Management Algorithm

Malassezia restricta as an unexpected cause of infectious osteomyelitis diagnosed by metagenomic sequencing: a case report and literature review

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