Diagnosis Of Spinal Infection Research Articles

Imaging in spinal infections: Current status and future directions

Imaging plays an important role in the diagnosis of spinal infections. Early diagnosis is paramount in the treatment of spinal infections and leads to improved outcomes. This article reviews the imaging and relevant clinical details of infections of the spine: pyogenic spondylodiscitis, tuberculous spondylodiscitis, septic facet arthritis, epidural abscess, and subdural abscess. Though radiographs can reveal subtle changes with infections, advanced imaging modalities have increased sensitivity to aid in early diagnosis. Magnetic resonance imaging (MRI) is emphasized given it is generally the most sensitive and specific advanced imaging modality. However, nuclear medicine imaging and computer tomography (CT) play a role diagnosis in cases where MRI is not available or contra-indicated. Additionally, CT is also important for image-guided biopsy to guide antimicrobial treatment.

Paraspinal muscles atrophy on both sides and at multiple levels after unilateral lumbar partial discectomy.

To identify the changes in cross-sectional areas (CSAs) and fatty infiltration of both sides of the paravertebral muscles and their associations with prognostic factors in patients who underwent unilateral lumbar discectomy. We retrospectively reviewed 27 patients who underwent magnetic resonance imaging before and after 1- or 2-level lumbar discectomy. The CSAs and functional cross-sectional areas of the paraspinal muscles were bilaterally measured from L1 to L2 to L5 to S1 based on T2-weighted axial images. These parameters were compared pre-and postoperatively. CSAs and functional cross-sectional areas decreased also in non-operative, non-surgical levels, not only in operated levels after discectomy. In the correlation analysis, the CSA of psoas major muscle at L1 to L2 was significantly decreased in patients with lower preoperative lordosis (r = 0.598, P = .040). The postoperative CSA of psoas major muscle at L4 to L5 was lower in those with the higher Pfirrmann grade (r = -0.590, P = .002); however, the CSA of quadratus lumborum muscle at L1 to L2 showed the opposite result (r = 0.526, P = .036). Similar results were also observed in the partial correlation adjusted for age and postoperative duration. Patients who underwent discectomy experienced overall paraspinal muscle atrophy in the lumbar region, including surgical and non-surgical sites. Such atrophic changes emphasized the need for core strengthening and lumbar rehabilitation from the early period after partial discectomy.

Diagnosis of Spinal Infection with Alpha-defensin Lateral Flow Test: A Preliminary Report.

The alpha-defensin lateral flow test has been used in periprosthetic joint infection as a diagnostic support tool because of its simplicity and speed. However, the test has not been used to diagnose spinal infections. The purpose of this study was to investigate the efficacy of the alpha-defensin lateral flow test for diagnosing spinal infections. The subjects were 11 patients who were suspected of having spinal infections from October 2019 to August 2021 and underwent biopsies at a single institution. There were nine male and two female patients, with an average age of 60.7 (14-87) years. For diagnosing infection, the patient's consent for biopsy was obtained, and the sample was collected by computed tomography-guided aspiration biopsy or open biopsy at the site considered to be a possible abscess. The samples were subjected to a bacterial culture test, an acid-fast bacillus culture test, and an alpha-defensin lateral flow test (SynovasureⓇ lateral flow test; Zimmer Biomet, IN, USA). Of the 11 suspected spinal infections, the alpha-defensin lateral flow test was positive in 8 cases, negative in 2 cases, and undeterminable in 1 case. Of the 10 cases excluding the undeterminable case, the definitive diagnosis was 9 cases of spinal infection (spondylitis: 6 cases, spinal implant infection: 3 cases) and 1 case of vertebral body fracture. The alpha-defensin lateral flow test demonstrated a sensitivity of 88.9%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 50%. The biopsy sample culture test demonstrated a sensitivity of 77.8%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 33.3%. We suggested that the alpha-defensin lateral flow test might be useful as a diagnostic support tool for spinal infections.

Diagnostic efficiency of metagenomic next-generation sequencing on spinal infection and prognosis.

Spinal infection is a rare infectious disease that is difficult to treat. The incidence of spinal infection is on the rise with the experiential use of antibiotics, the increasing incidence of drug-resistant bacteria, and the improvement of detection techniques. Traditional detection methods have limitations such as low sensitivity and long time-consuming in the diagnosis of spinal infection. In the clinical diagnosis and treatment of spinal infection, it has always been the focus and difficulty to determine the type of pathogens and to use antibiotics in a targeted manner. Many patients in the early stage of spinal infection due to the limitations of traditional detection methods cannot be quickly and accurately diagnosed, resulting in diagnosis delay, missed the best treatment time, bringing disastrous consequences to patients. There is an urgent need for a high-specificity, high-sensitivity, and time-saving test technique in clinical practice, which can simultaneously distinguish and identify the pathogen of spinal infection. Metagenomic next-generation sequencing (mNGS) is a new frontier technology emerging in recent years. It can detect all known pathogens in samples and has been used to diagnose clinically atypical and rare infectious diseases. This study aims to analyze the sensitivity of mNGS technique in diagnosing pathogens after spinal infection and its effect on prognosis. Clinical data of 82 patients with spinal infection admitted to Xiangya Hospital of Central South University from January 2019 to December 2021 were retrospectively analyzed. Peripheral blood erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin (PCT) were routinely performed before surgery, and focal tissue specimens were obtained during surgery. Microbial culture, histopathological examination, and mNGS detection were performed. All patients were assigned into a targeted medication group (n=71) and an experienced treatment group (n=1) based on the results of mNGS. After regular follow-up, the sensitivity of mNGS to detect pathogens of spinal infection and its effect on prognosis were evaluated. The positive rate of mNGS (86.59%, 71/82) was significantly higher than that of microbial culture (18.99%, 15/79) and PCT (30.23%, 13/43). There were no significant differences in preoperative temperature, white blood cell count, neutrophil ratio, and scores of Visual Analogue Scale between the targeted medication group and the experienced treatment group. Preoperative use of antibiotics had no significant effect on the positive rate of mNGS and microbial culture (P=0.681). According to the targeted medication group, postoperative CRP and ESR showed a decreasing trend, and the ESR was significantly lower than that of the experienced treatment group at 30 days follow-up (P=0.044). Compared with the microbial culture or PCT, mNGS has a higher sensitivity rate to detect pathogens of spinal infection. Patients receiving targeted antibiotics based on the results of mNGS have better outcomes than those receiving the experienced medicine.

The potential of metagenomic next-generation sequencing in diagnosis of spinal infection: a retrospective study.

Metagenomic next-generation sequencing (mNGS) is a new approach to identify the infecting organism in infectious diseases. Our aim was to evaluate the accuracy of mNGS in determining the etiology of spinal infection. In this retrospective study, patients who had a suspected spinal infection and underwent mNGS for diagnosis in our hospital were eligible for inclusion. Samples for mNGS, culture, and histopathological tests were collected surgically or with a CT-guided needle biopsy. Sensitivity and specificity were calculated for mNGS and culture test, using histopathological results as reference. A total of 31 mNGS tests in 30 cases were included. Twenty-six cases were classified as infected, and four cases were considered aseptic. mNGS achieved a specificity of 75.0% [95% confidence interval (CI), 21.9% to 98.7%], sensitivity was 70.3% (95% CI, 49.7% to 85.5%). mNGS was more sensitive than culture at 14.8% (95% CI, 4.9% to 34.6%, P < 0.0001). However, the specificities of mNGS and culture were statistically similar. We described here the power of mNGS in the etiological diagnosing of spinal infection. Our study opens the possibility for more extensive use of mNGS techniques in the identification of pathogens in patients with suspected spinal infection.

Analytic Study of Spinal Infections: Clinical Picture, Treatment, and Outcomes in King Fahad Military Medical Complex in Dhahran, Saudi Arabia

Objective: To evaluate the prevalence of spinal infection in a hospital located in the eastern region of Saudi Arabia through a retrospective review and to identify the associated etiological agents in terms of clinical picture, treatment, and outcomes. Design: Retrospective cross-sectional study. Setting: Single hospital in Dhahran, Saudi Arabia. Patients: Patients with any type of spinal infection and/or who had undergone neurosurgical intervention for spinal infection between January 2006 and December 2018. Methods: We collected data on all patients with an established diagnosis of spinal infection from January 2006 to December 2018 in the King Fahad Military Medical Complex in Dhahran, Saudi Arabia. A validated and structured checklist was used for data collection. Spinal infection diagnosis was based on the clinical manifestation, microbiological evidence, radiological findings, and antimicrobial therapy response. Results: Seventeen patients were included in this study, and their mean age was 54.93 years. Twelve of the patients were male and four were female. The approximate time from symptom onset to diagnosis was 2 - 6 months. Most of the patients experienced back pain, with lumbosacral spondylitis being the most commonly cited type (61.11%), followed by thoracolumbar spondylodiscitis (25%) and cervical spondylodiscitis (6.25%). The most frequently isolated organism was Mycobacterium tuberculosis (8 patients, 50%), followed by extended-spectrum beta lactamase (ESBL)-producing Escherichia coli (4 patients, 25%), Brucella spp (3 patients, 18.75%), Staphylococcus aureus (1 patient, 6.25%), and Quambalaria cyanescens (1 patient, 6.25%). Totally, in 50% of the patients with thoracolumbar and lumbosacra site involvement, tuberculosis spondylodiscitis was observed, while another 50% of the cases showed complications associated with paravertebral abscess that required surgical drainage. Conclusion: M. tuberculosis was found to be the major cause of infectious spondylodiscitis. Additionally, Quambalaria cyanescens was isolated; this is the second reported case of the organism being isolated and the first associated with spinal infection.

CORRELATION BETWEEN FINDINGS IN MAGNETIC RESONANCE AND BIOPSY IN THE DIAGNOSIS OF SPONDYLODISCITIS

ABSTRACT Objective To correlate magnetic resonance imaging (MRI) findings with the microbiological and anatomopathological diagnosis of spinal infection. Methods A retrospective, cohort review of online medical records (laboratory, anatomopathology and diagnostic imaging sector) of patients diagnosed with spondylodiscitis, who underwent a full spine MR scan between January 2014 and July 2018 at the Department of Orthopedics and Traumatology of the Universidade Federal de São Paulo. Results Staphylococcus aureus was the most commonly found etiological agent (57%). Blood culture was positive in 76% of cases and 82% of the patients who underwent biopsy had a spondylodiscitis diagnosis. Pain was the most prevalent clinical symptom and the lumbosacral spine was the most frequent site of infection. T1 hyposignal, T2/STIR hypersignal, and terminal plate destruction were verified in almost all MR scans. Conclusions No direct correlation was found between MR findings and any specific etiological agent. Blood culture and biopsy are important diagnostic tools that should be used for accurate diagnosis of the infectious agent . Level of evidence IV; Diagnostic Study.

Risk factors associated with poor clinical outcome in pyogenic spinal infections: 5-years' intensive care experience.

Management of pyogenic spinal infections (PSI) after the development of neurological deficit has not been specifically addressed in the literature. We aimed to describe real-life clinical outcomes of PSI in patients admitted to an intensive care unit with neurological deficit and identify factors associated with good prognosis. Consecutive patients admitted to ICU with a possible diagnosis of spinal infection over five years' period were included. Descriptive statistics were performed to examine the demographics and clinical parameters. The majority (71%) of patients were male. The mean age was 57.4 years (27-79), and 71% were > 50 years old. At least one underlying risk factor was identified in 68% of the patients; the most common comorbidity was diabetes mellitus (DM). All patients have presented with fever accompanied by a neurological deficit (86%) and back pain (79%). A complete recovery was achieved in 25% of patients. However, the majority of patients had adverse outcomes with 21.4% mortality, and 43% remaining neurological sequelae. Increased age with a cut-off of 65 years and pre-existing DM were identified as being associated with poor outcome. Mortality among patients admitted to ICU with PSI was significantly higher than reported in the literature. The residual neurological deficit was common, one-third of patients had remaining neurological sequelae, and only one-fourth had complete recovery. Increased age and background DM were the most important determinants of poor clinical outcome. The impact of DM appears to be much more important than currently recognised in this population.

Diagnostic performance of 18F-FDG PET/CT in patients with spinal infection: a systematic review and a bivariate meta-analysis.

Diagnosis of spinal infection (SI) is challenging and usually requires multiple tests. We aimed to perform a systematic review and a bivariate meta-analysis on the diagnostic role of 18F-FDG PET/CT in patients with SI. A comprehensive literature search of studies published through February 2019 in PubMed/MEDLINE and Cochrane library databases was carried out. Studies investigating the diagnostic performance of 18F-FDG PET/CT in patients with SI were eligible for inclusion in the qualitative analysis. For the quantitative analysis, pooled sensitivity, specificity, positive and negative likelihood ratio (LR+ and LR-) and diagnostic odds ratio (DOR) of 18F-FDG PET/CT in patients with suspected SI were calculated on a per examination-based analysis. Pooled data were presented with 95% confidence intervals (95% CI). Twenty-six articles (833 patients) using 18F-FDG PET/CT were eligible for the qualitative analysis. Twelve studies (396 patients) were selected for the meta-analysis. Overall, 18F-FDG PET/CT demonstrated a very good diagnostic performance in patients with SI and several studies underlined the value of 18F-FDG PET/CT in assessing the response to treatment. The bivariate meta-analysis on 18F-FDG PET/CT in patients with suspected SI provided the following results: sensitivity 94.8% (95% CI 88.9-97.6%) and specificity 91.4% (95% CI 78.2-96.9%). The pooled LR+, LR- and DOR were 4.7 (95% CI 2.9-7.7), 0.11 (95% CI 0.07-0.16) and 63.4 (95% CI 28.9-139), respectively. No significant heterogeneity or publication bias was found. 18F-FDG PET/CT demonstrated a very good diagnostic performance in patients with SI and can be used in patients in which MRI cannot be performed or is non-diagnostic or inconclusive. Several studies underlined the value of 18F-FDG PET/CT in assessing the response to treatment in patients with SI. Overall, larger multicentre and prospective studies and cost-effectiveness analyses are warranted.

Infections of the Spine and Spinal Cord in Children

AbstractInfection of the spine and spinal cord are uncommon in children which if not diagnosed and treated early in the course of disease can lead to spinal instability and devastating neurological outcome. The spectrum of spinal infection ranges from discitis/osteomyelitis, spinal epidural abscess, subdural abscess, spinal meningitis, arachnoiditis, neuritis, myelitis, and intramedullary abscess. Inability of the children to express themselves and nonspecific clinical features like abdominal pain, walking/crawling difficulty, and fever can result in difficult and delayed diagnosis. Imaging plays a critical role in diagnosis of spinal infection; its complication and treatment follow-up. Magnetic resonance imaging with gadolinium contrast is considered as the imaging modality of choice for evaluation of spinal and cord infections. Infectious mimics like chronic recurrent multifocal osteomyelitis, pars articular defect with active inflammatory changes, spondyloarthritis, Guillain-Barre syndrome, transverse myelitis, acute disseminated encephalomyelitis, and multiple sclerosis can pose diagnostic challenge on imaging. The aim of this article is to briefly review the imaging appearances of infection involving various spinal compartments, pattern of infection spread, its complications and various mimics.

Role of Magnetic Resonance Imaging in Evaluation of Tubercular Spondylitis: Pattern of Disease in 100 Patients with Review of Literature

The purpose of this study is to evaluate the role of magnetic resonance imaging (MRI) in evaluation of tubercular spondylitis and to correlate imaging findings with clinical severity of the disease. One hundred consecutive patients, who presented with features suggestive of spinal infections, were subjected to MRI examination. T1W and STIR images were obtained followed by T2W and post-contrast T1W images. Various imaging characteristics of spinal infections were noted and correlated with the clinical severity of the disease. Backache was the most common presenting symptom present in 86 %, while paraparesis was the most common sign seen in 62 %. The neurological status of the patients correlated well with MRI findings in the majority of the cases with an overall good correlation obtained in 96 % of cases. The majority of the vertebrae and intervertebral discs affected showed hypointensity or isointensity on T1W images and hyperintensity on T2W images. Epidural/dural disease was present in 74 % while 68 % of patients demonstrated decreased intervertebral disc height. Epidural extension and subligamentous spread was in 74 % and 90 % of patients respectively. MRI plays a vital role in early and accurate diagnosis of spinal infections. It is non-invasive and clearly demonstrates soft tissue anatomy and pathology which makes it superior to X-rays and Computed Tomography (CT). Imaging findings of tubercular spondylitis were also found to have a good correlation with the clinical status of the patients. Hence, it is of much help in the evaluation and assessment of patients presenting with features of spinal infections.

CORRELATION BETWEEN CLINICAL, RADIOLOGICAL AND OPERATIVE FINDINGS IN MANAGEMENT OF TUBERCULOUS AND PYOGENIC SPONDYLITIS.

Background: spinal infection is a major category of spinal diseases that is difficult to differentiate clinically from degenerative diseases or spinal neoplasm. Evaluation of the vertebral osteomyelitis and tuberculous spondylitis need an accurate and specific imaging modality to guide the invasive procedures for a definitive microbiological diagnosis and to spare patients with other disorders that might mimic these entities as aggressive neoplastic lesions of the spine. Aim of the work: The aim of this study was to determine the accuracy of MRI for discrimination between different types of spinal infections mainly between tuberculous spondylitis and pyogenic spondylitis. Material and methods: We did a retrospective study of MRI images of 30 patients who had confirmed spondylitis either tuberculous or pyogenic in their MRI of the spine. Then we correlate the clinical and operative findings with the preoperative radiology of the patients. Statistical analysis was performed with the Fisher exact test and Monte Carlo test. Results: The incidence of the following MRI findings was significantly higher in patients with tuberculous spondylitis than in those with pyogenic spondylitis a well-defined paraspinal abnormal signal was present in 14 patients 88% in tuberculous spondylitis vs 4 patients 28% in pyogenic spondylitis, a thin and smooth abscess wall was present in 14 patients 88% in TB vs 2 patients 14% in pyogenic spondylitis , presence of paraspinal or intraosseous abscess (15 patients 93% in TB vs 6 patients 42% in pyogenic infection, subligamentous spread or more than two vertebral levels was detected in 12 patients 75% in TB vs 5 patients 35% in pyogenic spondylitis. thick and irregular abscess wall was present in 5 patients 35% in pyogenic spondylitis vs 0% in TB, a horizontal bandlike sparing of the body was present in 4 patients 28% in pyogenic spondylitis vs 0% in TB. Hyperintense signal on T2-weighted images was more commonly observed in tuberculous spondylitis 15 patients 93% in tuberculous vs 8 patients 57% in pyogenic. The accuracy and specificity of preoperative MRI diagnosis correlated to the postoperative pathological findings was 100% of both types of spondylitis Conclusion: MRI is an accurate and sensitive modality in diagnosis of spinal infection. It also has a high specificity in differentiation of tuberculous spondylitis and pyogenic spondylitis. Key Words: Tuberculous Spondylitis, Pyogenic Osteomyelities, MRI Spine.

Long-term Functional Outcome in Pyogenic Spinal Infection

Retrospective. To assess long-term adverse functional outcome following pyogenic spinal infection using standardized outcome measures, Oswestry disability index (ODI), and medical outcomes study short form-36 (SF-36). There is minimal published data regarding the long-term functional outcome in pyogenic spinal infection. Previous studies have used heterogeneous, unreliable, and nonvalidated measure instruments yielding data that is difficult to interpret. All cases of pyogenic spinal infection presenting to a single institution managed operatively and nonoperatively from 1994 to 2004 were retrospectively identified. Follow-up was by clinical review and standardized questionnaires. Inclusion in each case was on the basis of consistent clinical, imaging, and microbiology criteria. Twenty-nine cases of pyogenic spinal infection were identified. Twenty-eight percent were managed operatively and 72% with antibiotic therapy alone. Nineteen patients (66%) had an adverse outcome at a median follow-up of 61 months, despite only 5 patients (17%) having persistent neurologic deficit. A significant difference in SF-36 physical function scores was observed between patients with adverse outcome and patients who recovered (P = 0.003). SF-36 scores of all patients, regardless of management or outcome, failed to reach those of a normative population. A strong correlation was observed between ODI and SF-36 physical function scores (rho = 0.61, P < 0.05). Seventeen percent (n = 5) of admissions resulted in acute sepsis-related death. Delay in diagnosis of spinal infection (P = 0.025) and neurologic impairment at diagnosis (P < 0.001) were significant predictors of neurologic deficit at follow-up. Previous spinal surgery was associated with adverse outcome in patients requiring readmission within 1 year of hospital discharge following first spinal infection (P = 0.018). No independent predictors of adverse outcome, persistent neurologic impairment, readmission within 1 year, or acute death were identified by logistical regression analysis. High rates of adverse outcome detected using SF-36 and ODI suggest under-reporting of poor outcome when American Spinal Injury Association score alone is used to qualify outcome.

Broad-range PCR as a supplement to culture for detection of bacterial pathogens in patients with a clinically diagnosed spinal infection

We aimed to evaluate broad-range PCR and subsequent sequencing compared to conventional culture in the diagnosis of spinal infection. The method was a prospective study of all patients admitted to Aarhus University Hospital for surgery during a 12-months period with a clinically diagnosed infection of the spine. Samples from patients undergoing surgery for non-infectious causes (malignancy etc.) were included as control group. Specimens were submitted to conventional culture and molecular investigation with 16S rRNA gene amplification and sequence analysis. 38 patients were included in the study (clinically diagnosed spinal infections=18; non-infectious diseases=20). The specificity was excellent for both culture and PCR (95% and 100%, respectively). A true culture positive result was obtained in 50% of patients (9/18) and 61% was positive (11/18) by broad-range PCR. When combined, culture and PCR allowed for a microbiological diagnosis in 72% of patients (13/18). A positive culture was found only in patients treated < or =7 d compared to < or =16 d for PCR. However, PCR and culture result were equally negatively affected by duration of treatment. The combination of culture and broad-range PCR substantially adds to the number of microbiological diagnoses obtained, and improves the clinician's opportunity to tailor therapy to individual patients.

The Imaging of Spinal Infections

Spinal infections can arise in a variety of anatomical locations and structures and encompass vertebral osteomyelitis, discitis, disc space infection, epidural abscesses, and infection of the adjacent soft tissue structures. Plain radiography, computed tomography, magnetic resonance imaging (MRI), and nuclear imaging all have a role in the diagnosis of spinal infection. MRI continues to be the gold standard for the imaging diagnosis of spinal infections. 67 Gallium citrate and Tc-99m-methylene diphosphonate scintigraphy have become the standard for nuclear imaging of the spine. Fluorine-18-fluorodeoxyglucose positron emission tomography, strepavidin/ 111 In-biotin, and 99m -ciprofloxacin have shown promise for aiding in the diagnosis and evaluation of spinal infection but warrant further study.

Radionuclide imaging of spinal infections

The diagnosis of spinal infection, with or without implants, has been a challenge for physicians for many years. Spinal infections are now being recognised more frequently, owing to aging of the population and the increasing use of spinal-fusion surgery. The diagnosis in many cases is delayed, and this may result in permanent neurological damage or even death. Laboratory evidence of infection is variable. Conventional radiography and radionuclide bone imaging lack both sensitivity and specificity. Neither in vitro labelled leucocyte scintigraphy nor 99mTc-anti-granulocyte antibody scintigraphy is especially useful, because of the frequency with which spinal infection presents as a non-specific photopenic area on these tests. Sequential bone/gallium imaging and 67Ga-SPECT are currently the radionuclide procedures of choice for spinal osteomyelitis, but these tests lack specificity, suffer from poor spatial resolution and require several days to complete. [18F]Fluoro-2-deoxy-D-glucose (FDG) PET is a promising technique for diagnosing spinal infection, and has several potential advantages over conventional radionuclide tests. The study is sensitive and is completed in a single session, and image quality is superior to that obtained with single-photon emitting tracers. The specificity of FDG-PET may also be superior to that of conventional tracers because degenerative bone disease and fractures usually do not produce intense FDG uptake; moreover, spinal implants do not affect FDG imaging. However, FDG-PET images have to be read with caution in patients with instrumented spinal-fusion surgery since non-specific accumulation of FDG around the fusion material is not uncommon. In the future, PET-CT will likely provide more precise localisation of abnormalities. FDG-PET may prove to be useful for monitoring response to treatment in patients with spinal osteomyelitis. Other tracers for diagnosing spinal osteomyelitis are also under investigation, including radiolabelled antibiotics, such as 99mTc-ciprofloxacin, and radiolabelled streptavidin-biotin complex. Antimicrobial peptides display preferential binding to microorganisms over human cells and perhaps new radiopharmaceuticals will be recruited from the array of human antimicrobial peptides/proteins. In experiments with Tc-ubiquicidin-derived peptides, radioactivity at the site of infection correlated well with the number of viable bacteria present. Finally, radiolabelled antifungal tracers could potentially distinguish fungal from bacterial infections.

Editorial Comment

Editorial Comment

Imaging of infectious spinal disorders in children and adults

The aim of this review article is to outline the imaging of infectious disorders of the spine in adults and children. The clinical presentation, potential routes of infection and the pathogens commonly identified are discussed. The value of different imaging modalities in the diagnosis of spinal infection is presented including radiographic, CT, MR imaging and Nuclear Medicine including PET. The use of image guided techniques for diagnosis and subsequent treatment is briefly covered. The major differential diagnoses of infectious disorders of the spine are identified and contrasted with the typical findings in infection. The use of follow up imaging is evaluated.

MR IMAGING OF SPINAL INFECTIONS

In the appropriate clinical situation, MR imaging is a powerful tool in the diagnosis of spinal infection. Imaging of spinal infections requires the use of a combination of T1-weighted and T2-weighted or STIR sequences. Contrast enhancement is useful and helps to define paraspinal and epidural disease. Knowledge of potential pitfalls with MR imaging and of normal marrow conversion is required. With these points in mind, MR imaging will be beneficial in the care of patients with spinal infections.

当科における化膿性脊椎炎および結核性脊椎炎の治療経験

Diagnosis and treatment of 24 pyogenic spondylitis and 5 tuberculous spondylitis cases were examined. Twenty two patients underwent needle biopsies for spinal infection and correct useful in the diagnosis of spinal infection. Three of the 11 operated patients were treated by instruments, and their clinical results were excellent. However, we considered that instrumentation surgery for spinal infection should be performed only when a rigid fixation was necessary.