Abstract
Spondylodiscitis accounts for 2–7% of osteomyelitis cases and is characterized by pain, systemic inflammation, and permanent neurological deficits. We aimed to identify imaging characteristics and clinical parameters to successfully predict microbiological pathogens by computed tomography (CT)-guided biopsy in suspected spondylodiscitis cases. Forty consecutive patients (mean age 65.1 years) with suspected spondylodiscitis underwent CT-guided biopsy. CT features (non-sclerotic endplate erosions (NSEs)), magnetic resonance criteria (paravertebral/epidural abscess (PA/EA) formation), and clinical data (C-reactive protein (CRP) > 50 mg/L) were assessed for their predictive potential. NSEs were detected in 6/11 (54.5%) and 1/29(3.4%) patients with positive and negative microbiology, respectively. PA and EA, respectively, were present in 7/11(63.6%) and 3/11 patients with positive microbiology and 7/29 (24.1%) and 2/29 patients with negative microbiology. CRP > 50 was observed in 7/11 (63.6%) and in 7/29 (24.1%) patients with positive and negative microbiology, respectively. Three double combinations possessed near-perfect specificity (PA + NSE, 100%; PA + CRP > 50, 96.6%; NSE + CRP > 50, 96.6%). The top three Youden indices included combinations with NSE. Since CT/magnetic resonance (MR) imaging and CRP are routinely used to evaluate spondylodiscitis, the presented diagnostic criteria and combinations can aid decision-making for biopsy.
Highlights
Spondylodiscitis accounts for 2–7% of osteomyelitis cases and has a reported annual incidence of1/100,000 to 1/250,000 [1]
Two detected pathogens correlated with results from computed tomography (CT)-guided biopsy while one additional pathogen was detected in a patient with negative microbiologic result following CT-guided biopsy
Endeavors to identify both clinical variables and imaging features predictive of microbiological pathogen detection in spondylodiscitis patients have been undertaken by several studies [6,8,15,16,21]
Summary
Spondylodiscitis accounts for 2–7% of osteomyelitis cases and has a reported annual incidence of1/100,000 to 1/250,000 [1]. Spondylodiscitis accounts for 2–7% of osteomyelitis cases and has a reported annual incidence of. Besides intervertebral discs and adjacent vertebral bodies, spondylodiscitis often affects the surrounding paravertebral and epidural spaces. Due to the proximity of key neurological structures, such as the spinal cord and neuroforaminal nerve roots, patients suffer from pain and systemic inflammation and are at risk of suffering permanent neurological. Med. 2020, 9, 32 deficits [2,3] and in some cases, death [4]. A fast induction of targeted antibiotic therapy is critical and may help prevent prolonged and complicated courses [5]
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