Abstract
Backgroundand objectives: The clinical assessment of therapeutic response in pyogenic vertebral osteomyelitis (PVO) has been usually performed based on the changes of clinical symptoms and blood inflammatory markers. Recently, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) has emerged as an alternative independent method. We analyzed the validity of the clinical assessment for detecting residual PVO based on 18F-FDG-PET. Materials and Methods: This study was conducted with 53 patients confirmed as lumbar PVO under retrospective design. All patients underwent clinical assessment using clinical symptoms and C-reactive protein (CRP) for therapeutic response after parenteral antibiotic therapy, which led to the decision of placement in the uncontrolled (group UC) or controlled (group C) group. The validity of clinical assessment was analyzed based on the cut-off values of FDG uptake for detecting residual PVO as references, which are already established in the previous literature. Results: The mean duration of parenteral antibiotic therapy and recurrence rate were 42.19 ± 15.84 (21–89) days and 9.4% (5/53), respectively. 18F-FDG-PETs were performed at 80 rounds of clinical assessment on 37.40 ± 13.15 (21–83) days of parenteral antibiotic therapy and divided: 31 into group UC and 49 into group C, according to the decisions of clinical assessment. Based on the cut-off values of FDG uptake, clinical assessment showed 48.4–58.1% of false positive for residual PVO in group UC. However, 18F-FDG-PET showed 8.2% (4/49) of false negative for residual PVO in group C, which led to recurrences. Conclusions: Clinical assessment using clinical symptoms and CRP for evaluating therapeutic response in PVO is still a useful method in terms of similar recurrence rate compared to 18F-FDG-PET. However, the high rate of false positive for residual PVO can prolong the use of unnecessary antibiotics and overall treatment period.
Highlights
The high rate of false positive for residual pyogenic vertebral osteomyelitis (PVO) can prolong the use of unnecessary antibiotics and overall treatment period
Spine infection is an infectious disease of the vertebrae and adjacent structures presented as vertebral osteomyelitis and can develop from pyogenic, tuberculous, and other causes [1]
Among the 80 patients, 27 patients were excluded for the following reasons: lost to follow-up or participation withdrawal (n = 6), bone infection other than spine (n = 1), PVO lesion containing instrumentation or bone cement (n = 5), paraspinal or back muscle abscess without spondylodiscitis (n = 5), and misdiagnosis (n = 10; four of tuberculous spinal infection, two of trauma, two of ankylosing spondylitis, and two of degenerative change)
Summary
Spine infection is an infectious disease of the vertebrae and adjacent structures presented as vertebral osteomyelitis and can develop from pyogenic, tuberculous, and other causes [1]. Pyogenic vertebral osteomyelitis (PVO) is most common. PVO shows non-specific symptoms and may not necessarily present with fever [3,4]. PVO would have already progressed with spondylodiscitis and abscess of epidural or paravertebral structures before diagnosis [5]. Half of PVO cases are still treated with empirical antibiotics because of culture-negative for causative microorganism despite several culturing attempts [6]. There are still no clear guidelines for treating PVO due to variability in causative microorganisms and antibiotic resistance among the regions [7]
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