Disco-vertebral Biopsy Research Articles

Mycobacterium xenopi spinal infections after discovertebral surgery: investigation and screening of a large outbreak

Mycobacterium xenopi spinal infections were diagnosed in 1993 in patients who had undergone surgical microdiscectomy for disc hernia, by nucleotomy or microsurgery, in a private hospital. Contaminated tap water, used for rinsing surgical devices after disinfection, was identified as the source of the outbreak. Several cases were recorded in the 4 years after implementation of effective control measures because of the long time between discectomy and case detection. The national health authorities decided to launch a retrospective investigation in patients who were exposed to M xenopi contamination in that hospital. Mailing and media campaigns were undertaken concurrently to trace exposed patients for spinal infections. Patients were screened by magnetic resonance imaging (MRI), and the scans were reviewed by a radiologist who was unaware of the diagnosis. Suspected cases had discovertebral biopsy for histopathological and bacteriological examination. Of 3244 exposed patients, 2971 (92%) were informed about the risk of infection and 2454 (76%) had MRI. Overall, 58 cases of M xenopi spinal infection were identified (overall cumulative frequency 1.8%), including 26 by the campaign (mean delay in detection 5.2 years, SD 2.4, range 1-10 years). Multivariate analysis showed that the risk of M xenopi spinal infection was related to nucleotomy and high number of patients per operating session. Failures in hygiene practices could result in an uncontrolled outbreak of nosocomial infection. Patients who have been exposed to an iatrogenic infectious hazard should be screened promptly and receive effective information.

An important differential diagnosis for persistent back pain

Between 1/1994 and 12/1998 40 patients with a vertebral osteomyelitis were treated at the Orthopedic University Hospital of Witten/Herdecke. All data of 15 female and 25 male patients with an mean age of 61 years (25-87 years) were analyzed in a retrospective study. Diagnosis of vertebral osteomyelitis was made between 1 and 84 weeks after onset of symptoms. Before admissions in our hospital up to 4 hospitalizations without proper diagnosis were reported. The treatment consisted bed-rest in an individual orthesis and percutaneous discovertebral biopsy before systemic administration of antibiotics. In 11 from a total of 21 biopsies we could prove bacteria as follows: 6 times Staphylococcus aureus, 2 times E. coli and 3 times Mycobacterium tuberculosis. Radiological diagnosis was made by conventional x-ray in 2 dimensions and nuclear magnetic resonance. Together with radiological, histological, microbiological and laboratory investigation we found 11 patients with a specific tuberculosis of the spine, 25 patients with a pyogenic vertebral osteomyelitis and 4 patients with a post-nucleotomy osteomyelitis. 14 patients underwent operative treatment. All patients were mobilized in an individual brace after CRP and ESR indicated remission of inflammation. DURATION OF HOSPITAL TREATMENT: Duration of the hospital treatment lasted between 33 and 137 days. At follow-up 12 months after demission 35 patients were free of symptoms, two patients had still signs of osteomyelitis, two patients, one of them with recurrence of spondylitis, were reoperated because of dislocation of the implants, and one patient died after surgery suffering from severe peritonitis and multi-organ-failure. We report pathogenesis and the current diagnostic and therapeutic concept of treatment of the vertebral osteomyelitis. Despite modern diagnostic possibilities, diagnosis of vertebral osteomyelitis is often made very late. Vertebral osteomyelitis is an important differential diagnosis for persistent back pain and needs to be considered more often.

Pyogenic and Tuberculous Spondylodiskitis (Vertebral Osteomyelitis) in 80 Adult Patients

Bacterial spondylodiskitis--i.e., adjacent vertebral osteomyelitis and diskitis--was studied in 80 adult patients. The infection was due to Mycobacterium tuberculosis in 31 cases (39%) and to pyogenic bacteria in 49 cases (61%). The latter pathogens included gram-negative bacilli in 16 cases (20%), Staphylococcus species in 15 (19%), Streptococcus species in 9 (11%), and Corynebacterium species in 1 (1%); the pathogens in the 8 remaining cases (10%) were not identified. Of the patients with tuberculous spondylodiskitis, 55% came from countries where tuberculosis is endemic (P < .001). Cases due to staphylococci and those due to M. tuberculosis were associated with a high frequency of previous active infection with those respective organisms at any site (47% and 42%, respectively; P < .001) and with a high rate of neurological complications (33% and 32%, respectively; P < .001). Nine patients with pyogenic spondylodiskitis (18%) but only one patient with tuberculous spondylodiskitis (3%) had diabetes mellitus (P < .05). Blood cultures were positive in 23 (56%) of the 41 cases of pyogenic spondylodiskitis due to an identified bacterium. Discovertebral needle biopsy contributed to the bacteriologic diagnosis in 29 (74%) of 39 cases.