Abstract
Background: Pyogenic vertebral osteomyelitis (PVO) is a bacterial infection involving the intervertebral disc, vertebral body, and paravertebral soft tissues. Damaged intervertebral structure is a major cause of persistent back pain even after successful antibiotic therapy, which can be improved by achieving autofusion or via additional surgical fixation. In this study, we analyzed the clinical and radiological features predicting intervertebral autofusion after successful antibiotic therapy in lumbar PVO. Methods: This study was retrospectively conducted with 32 patients (20 men and 12 women) diagnosed with lumbar PVO that was completely cured with no recurrences after antibiotic therapy. They were divided into two groups with (group A, n = 18) and without (group B, n = 14) intervertebral autofusion at six-month follow-up. Differences in back pain, blood inflammatory markers, and radiological features of PVO on simultaneous 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG-PET/MRI) of the intervertebral structure between the two groups were analyzed. Results: The mean duration of antibiotic therapy was 41.44 ± 14.21 (21–89) days. Group A showed a statistically higher erythrocyte sedimentation ratio (ESR; 59.28 ± 32.33 vs. 33.93 ± 18.76 mm/h, p = 0.014; normal range of ESR < 25), maximum standardized 18F-FDG uptake (SUVmax; 5.56 ± 1.86 vs. 3.98 ± 1.40, p = 0.013), and sustained extensive edematous changes on T2-weighted fat saturation (T2FS) MRI (p = 0.015) immediately after successful antibiotic therapy. However, no significant differences were observed in back pain, C-reactive protein, or the distribution of 18F-FDG uptake/contrast enhancement on 18F-FDG-PET/MRI (p > 0.05). Conclusions: Higher ESR and SUVmax of the intervertebral structure and sustained extensive edematous change on T2FS MRI immediately after successful antibiotic therapy are related with subsequent intervertebral autofusion, which should be carefully considered when assessing therapeutic response in PVO.
Highlights
Pyogenic vertebral osteomyelitis (PVO) is a bacterial infection involving the spine and adjacent structures [1]
Max of the intervertebral structure and sustained extensive edematous change on T2-weighted fat saturation (T2FS) magnetic resonance imaging (MRI) immediately after successful antibiotic therapy are related with subsequent intervertebral autofusion, which should be carefully considered when assessing therapeutic response in PVO
They were divided into two groups depending on whether autofusion was noted at six-month follow-up radiographs
Summary
Pyogenic vertebral osteomyelitis (PVO) is a bacterial infection involving the spine and adjacent structures [1]. They are usually treated with an average of about six weeks of empirical parenteral antibiotics [2,6]. The therapeutic response to antibiotic therapy for PVO has been assessed based on clinical symptoms and blood inflammatory markers. Clinical symptoms can vary between individuals, and blood inflammatory markers, including erythrocyte sedimentation ratio (ESR) and C-reactive protein (CRP), are affected by the other physical conditions [4]. Magnetic resonance imaging (MRI), recognized as the best imaging modality for spinal disease, is not helpful in determining therapeutic response of PVO. MRI cannot accurately distinguish the residual PVO lesions from the structural damage or the tissues restored after successful antibiotic therapy [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
