SAT0462 INTEREST OF FOLLOW-UP IMAGING EXAMINATIONS IN PATIENTS WITH PYOGENIC VERTEBRAL OSTEOMYELITIS: A RETROSPECTIVE STUDY

Abstract

Background: Systematic follow-up imaging in patients with pyogenic vertebral osteomyelitis (PVO) is widespread. However, it is discussed, and there is no recommendation. Objectives: Evaluate the interest of follow-up imaging examinations in patients with pyogenic vertebral osteomyelitis Methods: We conducted a retrospective cohort analysis of patients with PVO who had both baseline and follow-up imaging results available in a French university hospital during the period of 2010-2018. We have classified the follow-up images into two groups, improvement/stability and deterioration, compared with the baseline findings. For each patient, we compared their imaging follow-up to their clinical-biological condition assessed at the same time. Results: We have collected 80 patients. The median age was 71 years [32-89], 46 men, 13 patients had a history of spinal surgery. The most frequently reported germ was methicillin-sensitive staphylococci and the level of spinal involvement was predominantly lumbar. A Computerized Tomography (CT) was performed in 64% and a Magnetic Resonance Imaging (MRI) in 85% at the time of diagnosis. We identified 89 follow-up images, 58 MRIs, 31 CTs. The median delay of realisation was 85 days [11-364]. Soft tissue infiltration was observed in 50 patients compared to 26 on follow-up images but 3 were new. Similarly, 24% of the initial images had epiduritis compared to 16% during follow-up, 3% had appeared secondarily. There were 12% initial erosions described compared to 25% at follow-up. Of the 33 patients with clinical and biological recovery, 67% of follow-up images were classified as improving/stable and 33% as worsening (new abscesses (n=3), extension of soft tissue infiltration (n=2) and/or epiduritis (n=2) or appearance of new locations (n=2)). Among the 37 patients considered as unhealed, 87% of follow-up images were classified as improving/stable and 13% as worsening (new abscesses (n=1), extension of soft tissue infiltration (n=1) and/or epiduritis (n=1) or appearance of new locations (n=1)). Conclusion: Our study showed that there was no correlation between the clinical condition of patients and their follow-up imaging in the context of PVO. Clinical and biological evaluation seems sufficient to determine whether or not the patient is cured. Many images are made during the follow-up with a questionable cost/effectiveness ratio. A standard radiograph may be sufficient to provide a basic structural condition at the end of antibiotic therapy. Disclosure of Interests: None declared