Abstract
BackgroundDue to the unspecific symptoms of spondylodiscitis (SpD), an early radiological examination is necessary. However, controversially discussed is the need for magnetic resonance imaging of the entire spine to exclude multisegmental infections and to determine the required surgical interventions. The aims of this study were to assess the incidence of multilevel non-contiguous pyogenic SpD and compare comorbidities, pain symptoms, and subsequent surgical strategies between unifocal (uSpD) and multifocal (mSpD) SpD.MethodsWe retrospectively evaluated the data of patients with confirmed, surgically treated, pyogenic SpD who had received a total spine MRI in a single spine center between 2016 and 2018. MRI findings were classified according to Pola-classification and demographics, duration of clinical symptoms (pain and neurology) and Charlson Comorbidity-Index (CCI) results were compared between uSpD und mSpD groups. Surgical therapy was evaluated in patients with mSpD.ResultsuSpD was detected by MRI in 69 of 79 patients (87%). Of these, mSpD was detected in 10 patients (13%) with 21 infected segments (cervical and/ or thoracic and/ or lumbar region). Age and CCI were similar between uSpD and mSpD and 24 of all SpD regions were clinically unapparent. All patients with uSpD were treated operatively. In seven patients with mSpD, all infected levels of the spine were treated surgically in a one-stage procedure; one patient had a two-stage procedure and one patient had surgery at the lumbar spine, and an additional infected segment of the upper thoracic spine was treated conservatively. One patient died before a planned two-stage procedure was performed.ConclusionsDue to mSpD being found in approximately 13% of SpD cases, and considering the risk of overlooking an mSpD case, MRI imaging of the total spine is recommended. The detection of multiple infection levels can have an impact on the therapeutic strategy chosen.
Highlights
Due to the unspecific symptoms of spondylodiscitis (SpD), an early radiological examination is necessary
Literature regarding the widening of Magnetic resonance imaging (MRI) imaging, from local to total spine imaging, in cases of pyogenic SpD is controversial
These data highlight the opportunity to miss a non-contiguous SpD, recommendations for which cases an MRI of the entire spine should be performed are missing
Summary
Due to the unspecific symptoms of spondylodiscitis (SpD), an early radiological examination is necessary. The aims of this study were to assess the incidence of multilevel non-contiguous pyogenic SpD and compare comorbidities, pain symptoms, and subsequent surgical strategies between unifocal (uSpD) and multifocal (mSpD) SpD. One study found that 13% of spinal infections in patients with pyogen and specific (e.g. tuberculosis) SpD were noncontiguous [10] These data highlight the opportunity to miss a non-contiguous SpD, recommendations for which cases an MRI of the entire spine should be performed are missing. The primary aim of the study was to detect the frequency of unifocal (uSpD) and multifocal (mSpD) SpD in surgically treated SpD patients who had all an entire MRI of the spine. We compared patients with unifocal (uSpD) and multifocal (mSpD) SpD, regarding comorbidities, clinical symptoms, neurology to reveal risk factors underlining the need for an entire spine MRI to exclude noncontiguous SpD
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