CT-Guided Biopsy in Suspected Spondylodiscitis--The Association of Paravertebral Inflammation with Microbial Pathogen Detection.

Daniel Spira,Jessica Jesser,Michael Akbar,Burkhard Lehner,Stefan Hemmer,Christoph Rehnitz,Marc-André Weber,Thomas Germann,Anthony W.I. Lo

doi:10.1371/journal.pone.0146399

Daniel Spira, Jessica Jesser + Show 7 more

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https://doi.org/10.1371/journal.pone.0146399

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Journal: PloS one	Publication Date: Jan 4, 2016
Citations: 33	License type: CC BY 4.0

Affiliation: Heidelberg University, University Hospital Heidelberg

Abstract

ObjectivesTo search for imaging characteristics distinguishing patients with successful from those with futile microbiological pathogen detection by CT-guided biopsy in suspected spondylodiscitis.Methods34 consecutive patients with suspected spondylodiscitis underwent CT-guided biopsy for pathogen detection. MR-images were assessed for inflammatory infiltration of disks, adjacent vertebrae, epidural and paravertebral space. CT-images were reviewed for arrosion of adjacent end plates and reduced disk height. Biopsy samples were sent for microbiological examination in 34/34 patients, and for additional histological analysis in 28/34 patients.ResultsParavertebral infiltration was present in all 10/10 patients with positive microbiology and occurred in only 12/24 patients with negative microbiology, resulting in a sensitivity of 100% and a specificity of 50% for pathogen detection. Despite its limited sensitivities, epidural infiltration and paravertebral abscesses showed considerably higher specificities of 83.3% and 90.9%, respectively. Paravertebral infiltration was more extensive in patients with positive as compared to negative microbiology (p = 0.002). Even though sensitivities for pathogen detection were also high in case of vertebral and disk infiltration, or end plate arrosion, specificities remained below 10%.ConclusionsInflammatory infiltration of the paravertebral space indicated successful pathogen detection by CT-guided biopsy. Specificity was increased by the additional occurrence of epidural infiltration or paravertebral abscesses.

Highlights

Septic spondylodiscitis is an infection involving the vertebral endplates and the intervertebral disks predisposing patients toward serious neurologic deficits, disabling pain, and sometimes death
Paravertebral infiltration was present in all 10/10 patients with positive microbiology and occurred in only 12/24 patients with negative microbiology, resulting in a sensitivity of 100% and a specificity of 50% for pathogen detection
Paravertebral infiltration was more extensive in patients with positive as compared to negative microbiology (p = 0.002)

Summary

Introduction

Septic spondylodiscitis is an infection involving the vertebral endplates and the intervertebral disks predisposing patients toward serious neurologic deficits, disabling pain, and sometimes death. Even with unequivocal clinical and laboratory signs of infection and characteristic MR imaging features, the identification of the causative microbial pathogen is often requested and CT-guided biopsy can be performed to tailor antibiotic therapy. Recognition of the microbial agent is especially important in cases of atypical pathogens, such as multi-resistant agents or tuberculous infection. CT-guided biopsy of the spine is not a trivial procedure and may result in complications such as pain, paresis or hematoma formation [2,3]. Michel et al described successful isolation of the microbial agent in only 26.8% of patients biopsied [4], whereas Bontoux et al and Rieneck et al reported depiction of the microbial agent in 47.5%, and 57.1% of patients, respectively [5,6]. Imaging parameters predicting isolation of microbiological pathogens in suspected spondylodiscitis are needed to reduce unsuccessful bioptic attempts

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