Imaging and Management of Postoperative Spine Infection

Mazzie, Joseph P.; Brooks, Michael K.; Gnerre, Jeffrey

doi:10.1016/j.nic.2014.01.003

Cited by 34 publications

(18 citation statements)

References 36 publications

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“…Computed tomography (CT), another excellent modality to assess spinal instrumentation-related complications, can help qualify and quantify a fusion mass in an instrumented spine when instrumentation removal is contemplated [ 30 ]. In patients with contraindications for MRI, CT myelography can be used that may show the compression of neural structures by bony elements or others [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Etiology, Evaluation, and Treatment of Failed Back Surgery Syndrome

et al. 2018

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The study aimed to review the etiology of failed back surgery syndrome (FBSS) and to propose a treatment algorithm based on a systematic review of the current literature and individual experience. FBSS is a term that groups the conditions with recurring low back pain after spine surgery with or without a radicular component. Since the information on FBSS incidence is limited, data needs to be retrieved from old studies. It is generally accepted that its incidence ranges between 10% and 40% after lumbar laminectomy with or without fusion. Although the etiology of FBSS is not completely understood, it is possibly multifactorial, and the causative factors may be categorized into preoperative, operative, and postoperative factors. The evaluation of patients with FBSS symptoms should ideally initiate with reviewing the patients’ clinical history (observing “red flags”), followed by a detailed clinical examination and imaging (whole-body X-ray, magnetic resonance imaging, and computed tomography). FBSS is a complex and difficult pathology, and its accurate diagnosis is of utmost importance. Its management should be multidisciplinary, and special attention should be provided to cases of recurrent disc herniation and postoperative spinal imbalance.

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Section: Discussionmentioning

confidence: 99%

Etiology, Evaluation, and Treatment of Failed Back Surgery Syndrome

et al. 2018

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“… 12 CT is more useful than radiography for observing early changes in the vertebral bodies and end plates, but it is not effective for detecting soft tissue changes, which occur with the initiation of inflammation. 13 MRI is sensitive enough to observe changes in the early period of postoperative spondylodiscitis (3–5 days), 13 and the findings involve: (1) a decreased signal on T1-weighted MR images and an increased signal on T2-weighted MR images of the vertebral bodies and disc nucleus pulposus; (2) stenosis of the disc space; (3) bulging of the paraspinal soft tissue; and (4) decreased bony signal intensity of the adjacent vertebral body on T1-weighted images when gadolinium was used. In a recent systematic review, the sensitivity, specificity, and veracity were 93%, 97%, and 95%, respectively.…”

Section: Discussionmentioning

confidence: 99%

One-stage posterior debridement and fusion combined with irrigation and drainage for the treatment of postoperative lumbar spondylodiscitis

Zhang

et al. 2018

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThe aim of this study was to evaluate the clinical outcomes of one-stage posterior debridement, interbody fusion, and instrumentation, combined with irrigation and drainage, for treating lumbar spondylodiscitis.MethodsThe study included 23 patients (13 male and 10 female, mean age: 45 years) who had posterior debridement, interbody fusion, and instrumentation, followed by continuous closed irrigation and drainage for lumbar postoperative spondylodiscitis. The visual analog scale, Oswestry disability index, and lumbar lordosis angle were assessed before and after surgery to evaluate the clinical outcome.ResultsThe mean follow-up time was 27 (24–36) months. All patients tolerated the procedure well, and there were no instances of spondylodiscitis recurrence, though a dorsal dermal sinus developed in one patient after surgery. Infection was eliminated, as evidenced by the normalization of the erythrocyte sedimentation rates and C-reactive protein levels. The mean visual analog scale scores were significantly decreased after the operation. The mean lumbar lordosis angle before surgery was 21.61 ± 6.88° and the angle at the final follow-up was 31.61 ± 4.24°. The mean Oswestry disability index scores improved significantly both after the operation and at the follow-up visits (p < 0.05). Bone union was confirmed in all patients at a mean of 8.6 months post-operation, though this was not achieved until 2 years post-operation in one patient. All 3 patients who had neurological deficits showed great improvement at the last follow-up.ConclusionSurgical management using one-stage posterior debridement, interbody fusion, and instrumentation, followed by continuous closed irrigation and drainage, might be an effective treatment option for lumbar postoperative spondylodiscitis.Level of evidenceLevel IV, Therapeutic study.

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“…All papers, both original studies [102,106,108] and reviews [37,78,79,165,167,168], included for the evaluation of this statement agree that [ 18 F]FDG-PET/CT is an accurate imaging technique for post-surgical spine infection diagnosis with or without hardware. Even though the number of patients studied is still limited, evidence-based data indicate that [ 18 F]FDG-PET/CT has better diagnostic accuracy than other diagnostic modalities.…”

Section: F]fdg-pet/ct Can Detect Both Spine Infection and Soft Tissuementioning

confidence: 99%

“…Published data indicate that [ 18 F]FDG-PET/CT is superior to 67 Ga for the diagnosis of spinal infection and paraspinal soft tissue infection [82], and should be used in selected cases as an alternative to MRI [3,61,[94][95][96][97][98][99][100][101][102][103][104][105][106][107][108][109]. All studies in which a comparison between MRI and [ 18 F]FDG-PET/CT was performed have shown that a combination of the two techniques detects spinal infection in 100% of patients [102,110,111].…”

Section: Influence Of Medicationmentioning

confidence: 99%

Joint EANM/ESNR and ESCMID-endorsed consensus document for the diagnosis of spine infection (spondylodiscitis) in adults

Lazzeri

Bozzao

Cataldo

et al. 2019

Eur J Nucl Med Mol Imaging

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Purpose Diagnosis of spondylodiscitis (SD) may be challenging due to the nonspecific clinical and laboratory findings and the need to perform various diagnostic tests including serologic, imaging, and microbiological examinations. Homogeneous management of SD diagnosis through international, multidisciplinary guidance would improve the sensitivity of diagnosis and lead to better patient outcome. Methods An expert specialist team, comprising nuclear medicine physicians appointed by the European Association of Nuclear Medicine (EANM), neuroradiologists appointed by the European Society of Neuroradiology (ESNR), and infectious diseases specialists appointed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), reviewed the literature from January 2006 to December 2015 and proposed 20 consensus statements in answer to clinical questions regarding SD diagnosis. The statements were graded by level of evidence level according to the 2011 Oxford Centre for Evidence-based Medicine criteria and included in this consensus document for the diagnosis of SD in adults. The consensus statements are the result of literature review according to PICO (P:population/patients, I:intervention/indicator, C:comparator/control, O:outcome) criteria. Evidence-based recommendations on the management of adult patients with SD, with particular attention to radiologic and nuclear medicine diagnosis, were proposed after a systematic review of the literature in the areas of nuclear medicine, radiology, infectious diseases, and microbiology. Results A diagnostic flow chart was developed based on the 20 consensus statements, scored by level of evidence according to the Oxford Centre for Evidence-based Medicine criteria. Conclusions This consensus document was developed with a final diagnostic flow chart for SD diagnosis as an aid for professionals in many fields, especially nuclear medicine physicians, radiologists, and orthopaedic and infectious diseases specialists.

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Imaging and Management of Postoperative Spine Infection

Cited by 34 publications

References 36 publications

Etiology, Evaluation, and Treatment of Failed Back Surgery Syndrome

Etiology, Evaluation, and Treatment of Failed Back Surgery Syndrome

One-stage posterior debridement and fusion combined with irrigation and drainage for the treatment of postoperative lumbar spondylodiscitis

Joint EANM/ESNR and ESCMID-endorsed consensus document for the diagnosis of spine infection (spondylodiscitis) in adults

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