Interest of Follow-Up Radiological Imaging in Patients with Pyogenic Vertebral Osteomyelitis.

Sophie Hecquet,Clément Prati,Kévin Bouiller,Daniel Wendling,Frank Verhoeven,Catherine Chirouze,Sébastien Aubry

doi:10.3390/jcm10122690

Abstract

No recommendations are established for monitoring pyogenic vertebral osteomyelitis (PVO). Thus, the realization of systematic follow-up radiological imaging is controversial. The objective of this study was to evaluate the interest in follow-up radiological imaging in patients with PVO. We conducted a retrospective cohort analysis of patients with PVO who had both baseline and follow-up radiological imaging. We classified the follow-up images into two groups, improvement/stability, and deterioration, compared with the baseline data. For each patient, we compared their radiological imaging follow-up to their clinical-biological condition assessed at the same time. Eighty-six patients were included. The mean age was 68 years (±13). A total of 99 radiological imaging examinations at diagnosis and at follow-up were analyzed, 69 Magnetic Resonance Imaging (MRI), and 30 Computerized Tomography (CT scans). The mean delay between the follow-up radiological imaging and clinical evaluation was 2.8 +/− 2.1 months. Of the 36 patients with clinical and biological recovery, 24 patients (67%) had improved radiological imaging and 12 patients (34%) had radiological worsening (new abscesses (n = 4), extension of soft tissue infiltration (n = 2) and/or epiduritis (n = 2) or appearance of new locations (n = 1)). Among the 50 patients considered as unhealed, on the contrary, radiological imaging showed an improvement in imaging in 39 patients (78%) and a worsening in 11 patients (22%). Our study showed that there was no correlation between the clinical condition of patients and their follow-up radiological imaging in the context of PVO.

Highlights

Pyogenic vertebral osteomyelitis (PVO), called spondylodiscitis, septic discitis, and spinal osteomyelitis [1], represents 2% to 4% of osteoarticular infections [2]
The diagnosis of pyogenic vertebral osteomyelitis (PVO) was confirmed by a positive microbiologically sample and typical radiological features (with 1.5 Tesla Magnetic Resonance Imaging (MRI) (AREA, Siemens Medical systems, Erlangen, Germany) or Computerized Tomography (Somatom Definition AS+, Siemens Medical systems, Erlangen, Germany))
Patients were considered cured if they had recovered from their clinical condition prior to infection, and the C-reactive protein (CRP) had to be less than 10 mg/L

Summary

Introduction

Pyogenic vertebral osteomyelitis (PVO), called spondylodiscitis, septic discitis, and spinal osteomyelitis [1], represents 2% to 4% of osteoarticular infections [2]. Their incidence is steadily increasing due to the aging of the population and the rising number of people with immunocompromised conditions [3]. The follow-up radiological imaging of patients with PVO is not standardized. A study has highlighted the persistence of MRI anomalies up to 12 months after the introduction of an antibiotic therapy that has led to the clinical and biological recovery of a patient [10]. Little data are available on different radiological imaging follow-up modalities [12]

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