Value of CT-guided biopsy in the diagnosis of septic discitis

Enoch, David; Cargill, James S.; Laing, Rodney; Herbert, Sophie; Corrah, Tumena; Brown, Nicholas M.

doi:10.1136/jcp.2007.054296

Cited by 91 publications

(65 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Other authors continue to advocate early biopsy when blood culture is negative [11][12][13][14][15]. Disc space biopsy is associated with minimal morbidity and, for cases in which microbial identification is successful, aids in the selection of appropriate antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Some experts recommend a second percutaneous biopsy if the first one is negative Fig. 4 Distribution of the microbiological findings after percutaneous disc biopsies or blood cultures [11][12][13][14][15]. Friedman [16] reported positive initial percutaneous biopsy cultures for 50% of 24 patients with spontaneous spondylodiscitis, a frequency that improved to 79% on repeat biopsy.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Management of infectious discitis. Outcome in one hundred and eight patients in a University Hospital

Parra

Martín

Urda

et al. 2012

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose The optimal management of pyogenic discitis is not agreed on. We conducted a retrospective, cross-sectional, observational study in which all patients with discitis who attended Hospital San Carlos Madrid from January 1999 to January 2009 were included. Methods We identified 108 consecutive adult patients with infectious discitis. There were 49 men and 59 women with an average age of 67,5 (+/-16,89) years in the study group. Mean follow-up interval was 6,06 (12,5-2) years. 78 patients had spontaneous discitis and 30 patients had postoperative discitis. Inclusion criteria for the review were illness compatible with vertebral infection and / or evidence of spinal involvement on magnetic resonance imaging (MRI). Results In 56 percutaneous discal biopsy (52% patients) were positive in 28 cases. A single disc was infected in 100 patients. The segments involved were the cervical spine in four, the thoracic spine in 38 and the lumbar spine in 66. One or more comorbid diseases were present in 73 (68%) of 108 patients. Diabetes mellitus was the most common disease. Comorbid disease was rapidly fatal in four patients, ultimately fatal in seven patients, and nonfatal or not present in 97 patients (90 %). Conclusion Early diagnosis is a major challenge. Heightened awareness and the prompt use of MRI are necessary to avoid diagnostic delay. Prolonged antimicrobial therapy and the judicious application of timely surgical intervention are essential for an optimal outcome. Introduction and epidemiology

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of infectious discitis. Outcome in one hundred and eight patients in a University Hospital

Parra

Martín

Urda

et al. 2012

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…Culture from biopsy allows micro-organism identification in more than half of patients. Less invasive percutaneous biopsy is a safe procedure and can be taken either by guided CT-scan or by endoscopy [15]. Endoscopy also allows discectomy and drainage, and its performance for bacterial recovery is better than CT-guided spinal biopsy [68].…”

Section: Biopsymentioning

confidence: 99%

“…Since biopsy after antibiotic treatment may end in a negative culture [13,15], antibiotic suppression prior to the biopsy should be the rule. However this is a controverted issue as nearly 40% of spondylodiscitis without prior antibiotic treatment may present a negative culture [20].…”

Section: Biopsymentioning

confidence: 99%

Surgical treatment of spondylodiscitis. An update

Guerado

Cerván

2012

International Orthopaedics (SICOT)

195

132

View full text Add to dashboard Cite

Concept Spondylodiscitis refers to an infection affecting the intervertebral disk, the vertebral body or the posterior arch of the vertebra being aetiologically, pyogenic, granulomatous (tuberculosis, brucellosis, or fungal infection) or parasitic. Diagnosis Spondylodiscitis diagnosis is based on clinical symptoms, a combination of erythrocyte sedimentation rate with C-reactive protein (CRP) tests and, less useful, leukocytosis. Blood culture is also a very cost-effective method of identifying organisms. Plain radiographs are useful, however changes may take several months to appear. Radionuclide tests are currently less used; nevertheless, fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) shows encouraging results particularly when magnetic resonance images (MRI) are unconvincing in the distinction between degenerative changes and infection. MRI with gadolinium enhancement is the choice for image diagnosis. Management Medical management is usually the basis for treatment, alone or in combination with surgery. Surgical approach, either by endoscopy or open, is indicated for biopsy when clinical evolution is unsatisfactory and no micro-organism has been isolated, and also whenever a root, spinal cord or dural compression is seen on MRI; spinal instability or severe deformity are also clear indications for surgical treatment. Less invasive surgery either CT-scan guided or, particularly, by endoscopy has good results. However open surgery is still the standard. The anterior approach allows for anterior disc and bone debridement. The posterior approach is indicated when posterior elements are involved or in the presence of an epidural abscess. Although good results have been claimed, the use of instrumentation in the presence of an infected focus is controversial, as the use of cages or BMPs are.

show abstract

“…18 Enoch et al reviewed 98 CT-guided procedures in 103 patients; only 9 of 25 samples (36%) were positive for cultures. 11 In a 2013 retrospective study of image-guided biopsy, Kim et al reported a 97.1% overall success rate. They later claimed a 78.8% success rate (134/170) in the diagnosis of infection; however, this statistic is based on the diagnosis of infection by histology or clinical outcome.…”

mentioning

confidence: 99%

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

Garg

Kosmas

Young

et al. 2014

FOC

View full text Add to dashboard Cite

Object 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. Methods 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. Results 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. Conclusions 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.

show abstract

Value of CT-guided biopsy in the diagnosis of septic discitis

Abstract: Septic discitis is a serious condition with a wide variety of infective causes. CT-guided biopsy is a useful tool when the diagnosis of infectious spinal infection is considered in terms of commencing and targeting therapy, and it is a safe and well-tolerated procedure.

Cited by 91 publications

References 11 publications

Management of infectious discitis. Outcome in one hundred and eight patients in a University Hospital

Management of infectious discitis. Outcome in one hundred and eight patients in a University Hospital

Surgical treatment of spondylodiscitis. An update

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

Contact Info

Product

Resources

About