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Wangaryattawanich P, Condos AM, Rath TJ. Bacterial and Viral Infectious Disease of the Spine. Magn Reson Imaging Clin N Am 2024; 32:313-333. [PMID: 38555143 DOI: 10.1016/j.mric.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Spinal infections are a diverse group of diseases affecting different compartments of the spine with variable clinical and imaging presentations. Diagnosis of spinal infections is based on a combination of clinical features, laboratory markers, and imaging studies. Imaging plays a pivotal role in the diagnosis and management of spinal infections. The characteristic imaging manifestations of bacterial and viral infections in the spine are discussed with key teaching points emphasized.
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Affiliation(s)
- Pattana Wangaryattawanich
- Department of Radiology, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195-7115, USA.
| | - Amy M Condos
- Department of Radiology, University of Washington School of Medicine, 2545 Northeast 85th Street Seattle, WA 98115, USA
| | - Tanya J Rath
- Neuroradiology Section, Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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Crombé A, Fadli D, Clinca R, Reverchon G, Cevolani L, Girolami M, Hauger O, Matcuk GR, Spinnato P. Imaging of Spondylodiscitis: A Comprehensive Updated Review-Multimodality Imaging Findings, Differential Diagnosis, and Specific Microorganisms Detection. Microorganisms 2024; 12:893. [PMID: 38792723 PMCID: PMC11123694 DOI: 10.3390/microorganisms12050893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/11/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
Spondylodiscitis is defined by infectious conditions involving the vertebral column. The incidence of the disease has constantly increased over the last decades. Imaging plays a key role in each phase of the disease. Indeed, radiological tools are fundamental in (i) the initial diagnostic recognition of spondylodiscitis, (ii) the differentiation against inflammatory, degenerative, or calcific etiologies, (iii) the disease staging, as well as (iv) to provide clues to orient towards the microorganisms involved. This latter aim can be achieved with a mini-invasive procedure (e.g., CT-guided biopsy) or can be non-invasively supposed by the analysis of the CT, positron emission tomography (PET) CT, or MRI features displayed. Hence, this comprehensive review aims to summarize all the multimodality imaging features of spondylodiscitis. This, with the goal of serving as a reference for Physicians (infectious disease specialists, spine surgeons, radiologists) involved in the care of these patients. Nonetheless, this review article may offer starting points for future research articles.
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Affiliation(s)
- Amandine Crombé
- Department of Musculoskeletal Imaging, Pellegrin University Hospital, Bordeaux University, Place Amélie Raba-Léon, F-33000 Bordeaux, France
| | - David Fadli
- Department of Musculoskeletal Imaging, Pellegrin University Hospital, Bordeaux University, Place Amélie Raba-Léon, F-33000 Bordeaux, France
| | - Roberta Clinca
- Department of Radiology, IRCCS Policlinico di Sant’Orsola, 40138 Bologna, Italy
| | - Giorgio Reverchon
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Luca Cevolani
- Orthopedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Girolami
- Department of Spine Surgery Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Olivier Hauger
- Department of Musculoskeletal Imaging, Pellegrin University Hospital, Bordeaux University, Place Amélie Raba-Léon, F-33000 Bordeaux, France
| | - George R. Matcuk
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Zhang C, Liu S. The advancement of MRI in differentiating Modic type I degenerative changes from early spinal infections. Br J Radiol 2023; 96:20230551. [PMID: 37786986 PMCID: PMC10646657 DOI: 10.1259/bjr.20230551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 10/04/2023] Open
Abstract
MRI is the most sensitive and specific imaging method for the detection of advanced spinal infections. However, the differential diagnosis of early spinal infection and Modic Type I degenerative changes based on conventional MRI is difficult clinically, as they both may mimic each other by showing hypointensity on T1 weighted images and hyperintensity on T2 weighted spine MRI images. This review summarizes recent advancements in MRI, which may be useful in discriminating degenerative Modic Type I endplate changes from early spinal infection, and evaluates the diagnostic accuracy and limitations of MRI. We aim to provide indications for early differential diagnosis to help initiate appropriate treatment in a timely manner so that associated complications can be avoided.
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Lapa C, Rischpler C, Bundschuh RA, Dierks A, Lang S, Wassilew G, Alt V. Value of [18F]FDG PET/CT in Diagnosis and Management of Spondylodiscitis. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:544-551. [PMID: 37769687 DOI: 10.1055/a-2075-8873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Vertebral osteomyelitis is the third most common form of osteomyelitis in patients over 50 years of age.Whereas prompt (pathogen-directed) therapy is crucially associated with better outcomes, the heterogeneous clinical presentation of disease with unspecific symptoms often delays adequate treatment initiation. Diagnosis requires a careful investigation of medical history, clinical findings and diagnostic imaging, including magnetic resonance imaging and nuclear medicine techniques.Due to its high sensitivity, [18F]FDG PET/CT is becoming increasingly important in diagnosis and management of spondylodiscitis, especially in the postoperative setting with presence of spinal hardware or other implantable devices in which MRI is limited.
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Affiliation(s)
- Constantin Lapa
- Nuclear Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Deutsche Gesellschaft für Nuklearmedizin (DGN), Berlin, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- Department of Nuclear Medicine, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Alexander Dierks
- Nuclear Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Sigmund Lang
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Georgi Wassilew
- Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
- Sektion Muskuloskelettale Infektionen der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU), Berlin, Germany
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Lapa C, Rischpler C, Bundschuh RA, Dierks A, Lang S, Wassilew G, Alt V. Value of [18F]FDG PET/CT in diagnosis and management of spondylodiscitis. Nuklearmedizin 2023; 62:192-199. [PMID: 37224821 DOI: 10.1055/a-2042-9458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Vertebral osteomyelitis is the third most common form of osteomyelitis in patients over 50 years of age.Whereas prompt (pathogen-directed) therapy is crucially associated with better outcomes, the heterogeneous clinical presentation of disease with unspecific symptoms often delays adequate treatment initiation. Diagnosis requires a careful investigation of medical history, clinical findings and diagnostic imaging, including magnetic resonance imaging and nuclear medicine techniques.Due to its high sensitivity, [18F]FDG PET/CT is becoming increasingly important in diagnosis and management of spondylodiscitis, especially in the postoperative setting with presence of spinal hardware or other implantable devices in which MRI is limited.
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Affiliation(s)
- Constantin Lapa
- Nuclear Medicine, Faculty of Medicine, University Augsburg, Augsburg, Germany
- Deutsche Gesellschaft für Nuklearmedizin (DGN), Berlin, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- Department of Nuclear Medicine, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Alexander Dierks
- Nuclear Medicine, Faculty of Medicine, University Augsburg, Augsburg, Germany
| | - Sigmund Lang
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Georgi Wassilew
- Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
- Sektion Muskuloskelettale Infektionen der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU), Berlin, Germany
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Differentiating Magnetic Resonance Images of Pyogenic Spondylitis and Spinal Modic Change Using a Convolutional Neural Network. Spine (Phila Pa 1976) 2023; 48:288-294. [PMID: 36692159 DOI: 10.1097/brs.0000000000004532] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/23/2022] [Indexed: 01/25/2023]
Abstract
STUDY DESIGN A retrospective analysis of magnetic resonance imaging (MRI). OBJECTIVE The study aimed to evaluate the performance of a convolutional neural network (CNN) to differentiate spinal pyogenic spondylitis from Modic change on MRI. We compared the performance of CNN to that of four clinicians. SUMMARY OF BACKGROUND DATA Discrimination between pyogenic spondylitis and spinal Modic change is crucial in clinical practice. CNN deep-learning approaches for medical imaging are being increasingly utilized. METHODS We retrospectively reviewed MRIs from pyogenic spondylitis and spinal Modic change patients. There were 50 patients per group. Sagittal T1-weighted (T1WI), sagittal T2-weighted (T2WI), and short TI inversion recovery (STIR) MRIs were used for CNN training and validation. The deep learning framework Tensorflow was used to construct the CNN architecture. To evaluate CNN performance, we plotted the receiver operating characteristic curve and calculated the area under the curve. We compared the accuracy, sensitivity, and specificity of CNN diagnosis to that of a radiologist, spine surgeon, and two orthopedic surgeons. RESULTS The CNN-based area under the curves of the receiver operating characteristic curve from the T1WI, T2WI, and STIR were 0.95, 0.94, and 0.95, respectively. The accuracy of the CNN was significantly greater than that of the four clinicians on T1WI and STIR (P<0.05), and better than a radiologist and one orthopedic surgeon on the T2WI (P<0.05). The sensitivity was significantly better than that of the four clincians on T1WI and STIR (P<0.05), and better than a radiologist and one orthopedic surgeon on the T2WI (P<0.05). The specificity was significantly better than one orthopedic surgeon on T1WI and T2WI (P<0.05) and better than both orthopedic surgeons on STIR (P<0.05). CONCLUSION We differentiated between Modic changes and pyogenic spondylitis using a CNN that interprets MRI. The performance of the CNN was comparable to, or better than, that of the four clinicians.
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Spinal Infections. Neuroimaging Clin N Am 2023; 33:167-183. [DOI: 10.1016/j.nic.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Dagestad MH, Vetti N, Kristoffersen PM, Zwart JA, Storheim K, Bakland G, Brox JI, Grøvle L, Marchand GH, Andersen E, Assmus J, Espeland A. Apparent diffusion coefficient values in Modic changes – interobserver reproducibility and relation to Modic type. BMC Musculoskelet Disord 2022; 23:695. [PMID: 35869480 PMCID: PMC9306145 DOI: 10.1186/s12891-022-05610-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/29/2022] [Indexed: 11/21/2022] Open
Abstract
Background Modic Changes (MCs) in the vertebral bone marrow were related to back pain in some studies but have uncertain clinical relevance. Diffusion weighted MRI with apparent diffusion coefficient (ADC)-measurements can add information on bone marrow lesions. However, few have studied ADC measurements in MCs. Further studies require reproducible and valid measurements. We expect valid ADC values to be higher in MC type 1 (oedema type) vs type 3 (sclerotic type) vs type 2 (fatty type). Accordingly, the purpose of this study was to evaluate ADC values in MCs for interobserver reproducibility and relation to MC type. Methods We used ADC maps (b 50, 400, 800 s/mm2) from 1.5 T lumbar spine MRI of 90 chronic low back pain patients with MCs in the AIM (Antibiotics In Modic changes)-study. Two radiologists independently measured ADC in fixed-sized regions of interests. Variables were MC-ADC (ADC in MC), MC-ADC% (0% = vertebral body, 100% = cerebrospinal fluid) and MC-ADC-ratio (MC-ADC divided by vertebral body ADC). We calculated mean difference between observers ± limits of agreement (LoA) at separate endplates. The relation between ADC variables and MC type was assessed using linear mixed-effects models and by calculating the area under the receiver operating characteristic curve (AUC). Results The 90 patients (mean age 44 years; 54 women) had 224 MCs Th12-S1 comprising type 1 (n = 111), type 2 (n = 91) and type 3 MC groups (n = 22). All ADC variables had higher predicted mean for type 1 vs 3 vs 2 (p < 0.001 to 0.02): MC-ADC (10− 6 mm2/s) 1201/796/576, MC-ADC% 36/21/14, and MC-ADC-ratio 5.9/4.2/3.1. MC-ADC and MC-ADC% had moderate to high ability to discriminate between the MC type groups (AUC 0.73–0.91). MC-ADC-ratio had low to moderate ability (AUC 0.67–0.85). At L4-S1, widest/narrowest LoA were for MC-ADC 20 ± 407/12 ± 254, MC-ADC% 1.6 ± 18.8/1.4 ± 10.4, and MC-ADC-ratio 0.3 ± 4.3/0.2 ± 3.9. Difference between observers > 50% of their mean value was less frequent for MC-ADC (9% of MCs) vs MC-ADC% and MC-ADC-ratio (17–20%). Conclusions The MC-ADC variable (highest mean ADC in the MC) had best interobserver reproducibility, discriminated between MC type groups, and may be used in further research. ADC values differed between MC types as expected from previously reported MC histology. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05610-4.
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Okonkwo UC, Ohagwu CC, Aronu ME, Okafor CE, Idumah CI, Okokpujie IP, Chukwu NN, Chukwunyelu CE. Ionizing radiation protection and the linear No-threshold controversy: Extent of support or counter to the prevailing paradigm. JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2022; 253-254:106984. [PMID: 36057228 DOI: 10.1016/j.jenvrad.2022.106984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/07/2022] [Indexed: 06/15/2023]
Abstract
This study has developed a relationship that categorized radiation protection and allows for a proper, clear, and concise review of the different classifications in terms of principles of protection, dose criteria, categories, fundamental tools, exposure situations, applications and control measures. With the groundwork laid, advances of the linear no-threshold (LNT) model which has attracted attention in the field of radiobiology and epidemiology were examined in detail. Various plausible dose-response relationship scenarios were x-rayed under low-dose extrapolation. Intensive review of factors opposing the LNT model involving radiophobia (including misdiagnosis, alternative surgery/imaging, suppression of ionizing radiation (IR) research); radiobiology (including DNA damage repair, apoptosis/necrosis, senescence protection) and cost issues (including-high operating cost of LNT, incorrect prioritization, exaggeration of LNT impact, risk-to-benefit analysis) were performed. On the other hand, factors supporting the use of LNT were equally examined, they include regulatory bodies' endorsement, insufficient statistical significance, partial DNA repair, variability of irradiated bodies, different latency periods for cancer, dynamic nature of threshold and conflicting interests. After considering the gaps in the scientific investigations that either support or counter the scientific paradigm on the use of LNT model, further research and advocacy is recommended that will ultimately lead to the acceptance of an alternative paradigm by the international regulators.
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Affiliation(s)
- Ugochukwu C Okonkwo
- Department of Mechanical Engineering, Nnamdi Azikiwe University, Awka, Nigeria.
| | - Christopher C Ohagwu
- Department of Radiography and Radiological Sciences, Nnamdi Azikiwe University, Awka, Nigeria
| | - Michael E Aronu
- Department of Radiology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Christian E Okafor
- Department of Mechanical Engineering, Nnamdi Azikiwe University, Awka, Nigeria
| | - Christopher I Idumah
- Department of Polymer and Textile Engineering, Nnamdi Azikiwe University, Awka, Nigeria
| | - Imhade P Okokpujie
- Department of Mechanical and Mechatronic Engineering, Afe-Babalola University, Ado-Ekiti, Nigeria
| | - Nelson N Chukwu
- National Engineering Design Development Institute, Nnewi, Anambra State, Nigeria
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Herger N, Bermudez-Lekerika P, Farshad M, Albers CE, Distler O, Gantenbein B, Dudli S. Should Degenerated Intervertebral Discs of Patients with Modic Type 1 Changes Be Treated with Mesenchymal Stem Cells? Int J Mol Sci 2022; 23:ijms23052721. [PMID: 35269863 PMCID: PMC8910866 DOI: 10.3390/ijms23052721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 12/16/2022] Open
Abstract
Low back pain (LBP) has been among the leading causes of disability for the past 30 years. This highlights the need for improvement in LBP management. Many clinical trials focus on developing treatments against degenerative disc disease (DDD). The multifactorial etiology of DDD and associated risk factors lead to a heterogeneous patient population. It comes as no surprise that the outcomes of clinical trials on intradiscal mesenchymal stem cell (MSC) injections for patients with DDD are inconsistent. Intradiscal MSC injections have demonstrated substantial pain relief and significant disability-related improvements, yet they have failed to regenerate the intervertebral disc (IVD). Increasing evidence suggests that the positive outcomes in clinical trials might be attributed to the immunomodulatory potential of MSCs rather than to their regenerative properties. Therefore, patient stratification for inflammatory DDD phenotypes may (i) better serve the mechanisms of action of MSCs and (ii) increase the treatment effect. Modic type 1 changes—pathologic inflammatory, fibrotic changes in the vertebral bone marrow—are frequently observed adjacent to degenerated IVDs in chronic LBP patients and represent a clinically distinct subpopulation of patients with DDD. This review discusses whether degenerated IVDs of patients with Modic type 1 changes should be treated with an intradiscal MSC injection.
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Affiliation(s)
- Nick Herger
- Center of Experimental Rheumatology, University Hospital Zurich and Balgrist University Hospital, University of Zurich, CH-8008 Zurich, Switzerland; (N.H.); (O.D.)
| | - Paola Bermudez-Lekerika
- Tissue Engineering for Orthopaedics and Mechanobiology, Bone & Joint Program, Department for BioMedical Research (DBMR), Medical Faculty, University of Bern, CH-3008 Bern, Switzerland; (P.B.-L.); (B.G.)
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Medical Faculty, University of Bern, CH-3010 Bern, Switzerland;
| | - Mazda Farshad
- Department of Orthopaedics, Balgrist University Hospital, CH-8008 Zurich, Switzerland;
| | - Christoph E. Albers
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Medical Faculty, University of Bern, CH-3010 Bern, Switzerland;
| | - Oliver Distler
- Center of Experimental Rheumatology, University Hospital Zurich and Balgrist University Hospital, University of Zurich, CH-8008 Zurich, Switzerland; (N.H.); (O.D.)
| | - Benjamin Gantenbein
- Tissue Engineering for Orthopaedics and Mechanobiology, Bone & Joint Program, Department for BioMedical Research (DBMR), Medical Faculty, University of Bern, CH-3008 Bern, Switzerland; (P.B.-L.); (B.G.)
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Medical Faculty, University of Bern, CH-3010 Bern, Switzerland;
| | - Stefan Dudli
- Center of Experimental Rheumatology, University Hospital Zurich and Balgrist University Hospital, University of Zurich, CH-8008 Zurich, Switzerland; (N.H.); (O.D.)
- Correspondence: ; Tel.: +41-4451-07511
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Schmeel FC, Lakghomi A, Lehnen NC, Haase R, Banat M, Wach J, Handke N, Vatter H, Radbruch A, Attenberger U, Luetkens JA. Proton Density Fat Fraction Spine MRI for Differentiation of Erosive Vertebral Endplate Degeneration and Infectious Spondylitis. Diagnostics (Basel) 2021; 12:diagnostics12010078. [PMID: 35054245 PMCID: PMC8774963 DOI: 10.3390/diagnostics12010078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/31/2022] Open
Abstract
Vertebral Modic type 1 (MT1) degeneration may mimic infectious disease on conventional spine magnetic resonance imaging (MRI), potentially leading to additional costly and invasive investigations. This study evaluated the diagnostic performance of the proton density fat fraction (PDFF) for distinguishing MT1 degenerative endplate changes from infectious spondylitis. A total of 31 and 22 patients with equivocal diagnosis of MT1 degeneration and infectious spondylitis, respectively, were retrospectively enrolled in this IRB-approved retrospective study and examined with a chemical-shift encoding (CSE)-based water-fat 3D six-echo modified Dixon sequence in addition to routine clinical spine MRI. Diagnostic reference standard was established according to histopathology or clinical and imaging follow-up. Intravertebral PDFF [%] and PDFFratio (i.e., vertebral endplate PDFF/normal vertebrae PDFF) were calculated voxel-wise within the single most prominent edematous bone marrow lesion per patient and examined for differences between MT1 degeneration and infectious spondylitis. Mean PDFF and PDFFratio of infectious spondylitis were significantly lower compared to MT1 degenerative changes (mean PDFF, 4.28 ± 3.12% vs. 35.29 ± 17.15% [p < 0.001]; PDFFratio, 0.09 ± 0.06 vs. 0.67 ± 0.37 [p < 0.001]). The areas under the curve (AUC) and diagnostic accuracies were 0.977 (p < 0.001) and 98.1% (cut-off at 12.9%) for PDFF and 0.971 (p < 0.001) and 98.1% (cut-off at 0.27) for PDFFratio. Our data suggest that quantitative evaluation of vertebral PDFF can provide a high diagnostic accuracy for differentiating erosive MT1 endplate changes from infectious spondylitis.
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Affiliation(s)
- Frederic Carsten Schmeel
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (A.L.); (N.C.L.); (R.H.); (A.R.)
- Correspondence: ; Tel.: +49-0228-28716507; Fax: +49-0228-28714321
| | - Asadeh Lakghomi
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (A.L.); (N.C.L.); (R.H.); (A.R.)
| | - Nils Christian Lehnen
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (A.L.); (N.C.L.); (R.H.); (A.R.)
| | - Robert Haase
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (A.L.); (N.C.L.); (R.H.); (A.R.)
| | - Mohammed Banat
- Department of Neurosurgery, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (M.B.); (J.W.); (H.V.)
| | - Johannes Wach
- Department of Neurosurgery, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (M.B.); (J.W.); (H.V.)
| | - Nikolaus Handke
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (N.H.); (U.A.); (J.A.L.)
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (M.B.); (J.W.); (H.V.)
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (A.L.); (N.C.L.); (R.H.); (A.R.)
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (N.H.); (U.A.); (J.A.L.)
| | - Julian Alexander Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany; (N.H.); (U.A.); (J.A.L.)
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Boudabbous S, Paulin EN, Delattre BMA, Hamard M, Vargas MI. Spinal disorders mimicking infection. Insights Imaging 2021; 12:176. [PMID: 34862958 PMCID: PMC8643376 DOI: 10.1186/s13244-021-01103-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/03/2021] [Indexed: 12/23/2022] Open
Abstract
Spinal infections are very commonly encountered by radiologists in their routine clinical practice. In case of typical MRI features, the diagnosis is relatively easy to interpret, all the more so if the clinical and laboratory findings are in agreement with the radiological findings. In many cases, the radiologist is able to make the right diagnosis, thereby avoiding a disco-vertebral biopsy, which is technically challenging and associated with a risk of negative results. However, several diseases mimic similar patterns, such as degenerative changes (Modic) and crystal-induced discopathy. Differentiation between these diagnoses relies on imaging changes in endplate contours as well as in disc signal. This review sought to illustrate the imaging pattern of spinal diseases mimicking an infection and to define characteristic MRI and CT patterns allowing to distinguish between these different disco-vertebral disorders. The contribution of advanced techniques, such as DWI and dual-energy CT (DECT) is also discussed.
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Affiliation(s)
- Sana Boudabbous
- Division of Radiology, Department of Diagnosis, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland. .,Faculty of Medicine of the Geneva University, Geneva, Switzerland.
| | - Emilie Nicodème Paulin
- Division of Radiology, Medical Imaging Department, Hospital of Neuchatel, Neuchâtel, Switzerland
| | - Bénédicte Marie Anne Delattre
- Division of Radiology, Department of Diagnosis, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Faculty of Medicine of the Geneva University, Geneva, Switzerland
| | - Marion Hamard
- Division of Radiology, Department of Diagnosis, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Maria Isabel Vargas
- Faculty of Medicine of the Geneva University, Geneva, Switzerland.,Division of Neuroradiology, Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
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Ortiz AO, Levitt A, Shah LM, Parsons MS, Agarwal V, Baldwin K, Bhattacharyya S, Boulter DJ, Burns J, Fink KR, Hunt CH, Hutchins TA, Kao LS, Khan MA, Lo BM, Moritani T, Reitman C, Repplinger MD, Shah VN, Singh S, Timpone VM, Corey AS. ACR Appropriateness Criteria® Suspected Spine Infection. J Am Coll Radiol 2021; 18:S488-S501. [PMID: 34794603 DOI: 10.1016/j.jacr.2021.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 10/19/2022]
Abstract
Spine infection is both a clinical and diagnostic imaging challenge due to its relatively indolent and nonspecific clinical presentation. The diagnosis of spine infection is based upon a combination of clinical suspicion, imaging evaluation and, when possible, microbiologic confirmation performed from blood cultures or image-guided percutaneous or open spine biopsy. With respect to the imaging evaluation of suspected spine infection, MRI without and with contrast of the affected spine segment is the initial diagnostic test of choice. As noncontrast MRI of the spine is often used in the evaluation of back or neck pain not responding to conservative medical management, it may show findings that are suggestive of infection, hence this procedure may also be considered in the evaluation of suspected spine infection. Nuclear medicine studies, including skeletal scintigraphy, gallium scan, and FDG-PET/CT, may be helpful in equivocal or select cases. Similarly, radiography and CT may be appropriate for assessing overall spinal stability, spine alignment, osseous integrity and, when present, the status of spine instrumentation or spine implants. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- A Orlando Ortiz
- Chairman, Department of Radiology, Jacobi Medical Center, Bronx, New York.
| | - Alex Levitt
- Research Author, Jacobi Medical Center, Bronx, New York
| | - Lubdha M Shah
- Panel Chair, University of Utah, Salt Lake City, Utah
| | - Matthew S Parsons
- Panel Vice-Chair, Mallinckrodt Institute of Radiology, Saint Louis, Missouri
| | - Vikas Agarwal
- Vice-Chair of Education, Chief, Neuroradiology, and Director, Spine Intervention, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Keith Baldwin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, American Academy of Orthopaedic Surgeons
| | - Shamik Bhattacharyya
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts, American Academy of Neurology
| | - Daniel J Boulter
- Clinical Director, MRI, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Judah Burns
- Program Director, Diagnostic Radiology Residency Program, Montefiore Medical Center, Bronx, New York
| | | | | | - Troy A Hutchins
- Chief Value Officer, Department of Radiology, University of Utah Health, Salt Lake City, Utah
| | - Lillian S Kao
- Chief, Division of Acute Care Surgery, The University of Texas Health Science Center at Houston, Houston, Texas; and American Association for the Surgery of Trauma
| | - Majid A Khan
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Bruce M Lo
- Sentara Norfolk General/Eastern Virginia Medical School, Norfolk, Virginia; Board Member, American Academy of Emergency Medicine; and American College of Emergency Physicians
| | | | - Charles Reitman
- Medical University of South Carolina, Charleston, South Carolina; and Board of Directors, North American Spine Society
| | - Michael D Repplinger
- University of Wisconsin, Madison, Wisconsin; President, Dane County Medical Society; Councillor, American College of Emergency Physicians; and Society for Academic Emergency Medicine
| | - Vinil N Shah
- University of California San Francisco, San Francisco, California; and Executive Committee, American Society of Spine Radiology
| | - Simranjit Singh
- Indiana University School of Medicine, Indianapolis, Indiana; Secretary, SHM, Indiana Chapter; Secretary, SGIM, Midwest Region; and American College of Physicians
| | - Vincent M Timpone
- Co-Director, Neuroradiology Spine Intervention Service, Department of Radiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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Behzadmehr R, Doostkami M, Sarchahi Z, Dinparast Saleh L, Behzadmehr R. Radiation protection among health care workers: knowledge, attitude, practice, and clinical recommendations: a systematic review. REVIEWS ON ENVIRONMENTAL HEALTH 2021; 36:223-234. [PMID: 32894727 DOI: 10.1515/reveh-2020-0063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This study was performed to determine the knowledge, attitude, and practice (KAP) of health care workers (HCWs) towards radiation protection. METHODS In this systematic review study, three international databases (Web of Science, PubMed, Scopus) were searched for related published articles in the English language from 1 January 2000 to 1 February 2020. The quality of the included studies was evaluated using the Hoy et al. tool. RESULTS Out of the 1,848 studies examined, 41 studies that were performed on 11,050 HCWs were included in the final stage. The results indicated that in most studies, more than half (50%) of the participants had average knowledge. Furthermore, 60% of the participants had a positive attitude, but in most studies, they had average practice regarding radiation protection. The most important recommendation for improving KAP among the participants was incorporating radiation protection standards in the student curriculum. CONCLUSION Considering the results of the study, further attention should be paid to proper education regarding radiation protection standards and improvement of HCW performance.
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Affiliation(s)
- Razieh Behzadmehr
- Department of Radiology, Zabol University of Medical Sciences, Zabol, Sistan and Baluchestan, Iran
| | - Mahboobe Doostkami
- Department of Operating Room, School of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zohreh Sarchahi
- Department of Nursing, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | | | - Rezvaneh Behzadmehr
- Department of Radiology, Zabol University of Medical Sciences, Zabol, Sistan and Baluchestan, Iran
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Abdel Razek AAK, Mohamed Sherif F. Assessment of diffusion tensor imaging in differentiation between pyogenic and tuberculous spondylitis. Eur J Radiol 2021; 139:109695. [PMID: 33866120 DOI: 10.1016/j.ejrad.2021.109695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/10/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE to assess diffusion tensor imaging (DTI); an emerging technique for differentiation between pyogenic and tuberculous spondylitis. PATIENTS AND METHODS The study was carried out on 33 patients with infective spondylitis performing conventional MRI and DTI. The mean diffusivity (MD) and fractional anisotropy (FA) of the affected vertebral body were calculated by two readers. RESULTS The MD of pyogenic spondylitis of both readers (1.48 ± 0.09 and 1.47 ± 0.08 × 10-3 mm2/s) were significantly higher values (P = 0.001) than tuberculous spondylitis (1.11 ± 0.15 and 1.18 ± 0.08 × 10-3 mm2/s). The FA of pyogenic spondylitis of both readers (0.18 ± 0.09 and 0.20 ± 0.08) were significantly lower values (P = 0.001) than tuberculous spondylitis (0.30 ± 0.05 and 0.32 ± 0.03). There was a strong inter-reader agreement between both readers using MD (K = 0.963) and FA (K = 0.858). The thresholds MD and FA used for differentiating pyogenic and tuberculous spondylitis of both readers were 1.37 and 1.33 × 10-3 mm2/s and 0.21 and 0.25 with the area under the curve (AUC) of 0.927 and 0.831 respectively. Combined MD and FA revealed increased AUC to 0.97 and 0.98 of both readers respectively. CONCLUSION DTI with its parameters can be considered a noninvasive beneficial quantitative method that can help in differentiation between pyogenic and tuberculous spondylitis.
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Affiliation(s)
| | - Fatma Mohamed Sherif
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt
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16
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Prediction of skull base osteomyelitis in necrotising otitis externa with diffusion-weighted imaging. The Journal of Laryngology & Otology 2020; 134:404-408. [PMID: 32498734 DOI: 10.1017/s0022215120001073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To predict skull base osteomyelitis in patients with necrotising otitis externa using diffusion-weighted imaging. METHODS A retrospective analysis was conducted of 25 necrotising otitis externa patients with skull base osteomyelitis (n = 10) or without skull base involvement (n = 14) who underwent a single-shot diffusion-weighted imaging of the skull base. RESULTS The respective mean apparent diffusion coefficient values of the skull base, as determined by two reviewers, were 0.851 ± 0.15 and 0.841 ± 0.14 ×10-3mm2/s for the skull base osteomyelitis patients, and 1.065 ± 0.19 and 1.045 ± 0.20 ×10-3mm2/s for the necrotising otitis externa patients without skull base involvement. The difference in apparent diffusion coefficients between the groups was significant, for both reviewers (p = 0.008 and 0.012). The optimal threshold apparent diffusion coefficient for predicting skull base osteomyelitis in necrotising otitis externa patients was 0.945 ×10-3mm2/s and 0.915 ×10-3mm2/s, with an area under the curve of 0.825 and 0.800, accuracy of 87.5 and 83.3 per cent, sensitivity of 85.7 and 90.0 per cent, and specificity of 90.0 and 78.6 per cent, for each reviewer respectively. CONCLUSION Apparent diffusion coefficient is a non-invasive imaging parameter useful for predicting skull base osteomyelitis in necrotising otitis externa patients.
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Sequential PET/diffusion-weighted imaging in the evaluation of myocardial perfusion and viability in coronary artery disease: a preliminary study. Nucl Med Commun 2019; 41:40-47. [PMID: 31764594 DOI: 10.1097/mnm.0000000000001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the utility of sequential F-18 fluorodeoxyglucose PET/diffusion-weighted imaging in assessing myocardial perfusion and viability in coronary artery disease. METHODS Fourteen coronary artery disease patients and five non-coronary artery disease subjects underwent sequential cardiac F-18 fluorodeoxyglucose PET/diffusion-weighted imaging using a trimodality PET/computed tomography-MRI system. The perfusion data were acquired by measuring low b-values apparent diffusion coefficient using diffusion-weighted imaging. Regional myocardial viability was determined by perfusion/metabolism patterns. The perfusion/metabolism patterns obtained by low b-values apparent diffusion coefficient/fluorodeoxyglucose uptake were analyzed and compared with the results from the combination of rest methoxyisobutylisonitrile (Tc-MIBI) myocardial perfusion single-photon emission computed tomography with F-18 fluorodeoxyglucose PET/computed tomography. RESULTS Ten coronary artery disease patients and five non-coronary artery disease subjects were included in the final analysis. Low b-values apparent diffusion coefficient defects involved with 25 myocardial regions were demonstrated in nine coronary artery disease patients, while Tc-MIBI defects involved with 21 myocardial regions were shown in the same patients. The agreement between low b-values apparent diffusion coefficient and MIBI uptake was good in coronary artery disease patients (κ = 0.627, P < 0.001) and was better still in the whole subjects (κ = 0.733, P < 0.001). Low b-values apparent diffusion coefficient/fluorodeoxyglucose uptake demonstrated mismatch patterns in six coronary artery disease patients and MIBI/fluorodeoxyglucose uptake revealed mismatch patterns in seven coronary artery disease patients. Agreement in the evaluation of regional myocardial viability between low b-values apparent diffusion coefficient/fluorodeoxyglucose uptake and MIBI/fluorodeoxyglucose uptake was high in coronary artery disease patients (κ = 0.627, P < 0.001) and all subjects (κ = 0.728, P < 0.001). CONCLUSIONS Low b-values apparent diffusion coefficient/fluorodeoxyglucose uptake is comparable to MIBI/fluorodeoxyglucose uptake in assessing perfusion/metabolism patterns, indicating that microperfusion might dominate the diffusion signal at low b-values and sequential PET/diffusion-weighted imaging might be useful to evaluate myocardial viability in coronary artery disease patients.
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18
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Fields AJ, Battié MC, Herzog RJ, Jarvik JG, Krug R, Link TM, Lotz JC, O'Neill CW, Sharma A. Measuring and reporting of vertebral endplate bone marrow lesions as seen on MRI (Modic changes): recommendations from the ISSLS Degenerative Spinal Phenotypes Group. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2266-2274. [PMID: 31446492 DOI: 10.1007/s00586-019-06119-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 08/09/2019] [Accepted: 08/17/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE The positive association between low back pain and MRI evidence of vertebral endplate bone marrow lesions, often called Modic changes (MC), offers the exciting prospect of diagnosing a specific phenotype of chronic low back pain (LBP). However, imprecision in the reporting of MC has introduced substantial challenges, as variations in both imaging equipment and scanning parameters can impact conspicuity of MC. This review discusses key methodological factors that impact MC classification and recommends guidelines for more consistent MC reporting that will allow for better integration of research into this LBP phenotype. METHODS Non-systematic literature review. RESULTS The high diagnostic specificity of MC classification for a painful level contributes to the significant association observed between MC and LBP, whereas low and variable sensitivity underlies the between- and within-study variability in observed associations. Poor sensitivity may be owing to the presence of other pain generators, to the limited MRI resolution, and to the imperfect reliability of MC classification, which lowers diagnostic sensitivity and thus influences the association between MC and LBP. Importantly, magnetic field strength and pulse sequence parameters also impact detection of MC. Advances in pulse sequences may improve reliability and prove valuable for quantifying lesion severity. CONCLUSIONS Comparison of MC data between studies can be problematic. Various methodological factors impact detection and classification of MC, and the lack of reporting guidelines hinders interpretation and comparison of findings. Thus, it is critical to adopt imaging and reporting standards that codify acceptable methodological criteria. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Aaron J Fields
- Department of Orthopaedic Surgery, University of California, 513 Parnassus Avenue, S-1161, Box 0514, San Francisco, CA, 94143-0514, USA.
| | - Michele C Battié
- Faculty of Health Sciences and Western's Bone and Joint Institute, University of Western Ontario, London, ON, Canada
| | - Richard J Herzog
- Department of Radiology, Hospital for Special Surgery, New York, NY, USA
| | - Jeffrey G Jarvik
- Departments of Radiology, Neurosurgery and Health Services, and the Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, WA, USA
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California, 513 Parnassus Avenue, S-1161, Box 0514, San Francisco, CA, 94143-0514, USA
| | - Conor W O'Neill
- Department of Orthopaedic Surgery, University of California, 513 Parnassus Avenue, S-1161, Box 0514, San Francisco, CA, 94143-0514, USA
| | - Aseem Sharma
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Nouh MR. Imaging of the spine: Where do we stand? World J Radiol 2019; 11:55-61. [PMID: 31110605 PMCID: PMC6503457 DOI: 10.4329/wjr.v11.i4.55] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/11/2019] [Accepted: 03/16/2019] [Indexed: 02/06/2023] Open
Abstract
The number of patients presenting with spine-related problems has globally increased, with an enormous growing demand for the use of medical imaging to address this problem. The last three decades witnessed great leaps for diagnostic imaging modalities, including those exploited for imaging the spine. These developments improved our diagnostic capabilities in different spinal pathologies, especially with multi-detector computed tomography and magnetic resonance imaging, via both hardware and software improvisations. Nowadays, imaging may depict subtle spinal instability caused by various osseous and ligamentous failures, and could elucidate dynamic instabilities. Consequently, recent diagnostic modalities can discern clinically relevant spinal canal stenosis. Likewise, improvement in diagnostic imaging capabilities revolutionized our understanding of spinal degenerative diseases via quantitative biomarkers rather than mere subjective perspectives. Furthermore, prognostication of spinal cord injury has become feasible, and this is expected to be translated into better effective patient tailoring to management plans with better clinical outcomes. Meanwhile, our confidence in diagnosing spinal infections and assessing the different spinal instrumentation has greatly improved over the past few last decades. Overall, revolutions in diagnostic imaging over the past few decades have upgraded spinal imaging from simple subjective and qualitative indices into a more sophisticated yet precise era of objective metrics via deploying quantitative imaging biomarkers.
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Affiliation(s)
- Mohamed R Nouh
- Faculty of Medicine, Alexandria University, Alexandria 21521, Egypt
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Wang X, Zhou S, Bian Z, Li M, Jiang W, Hou C, Zhu L. Unilateral percutaneous endoscopic debridement and drainage for lumbar infectious spondylitis. J Orthop Surg Res 2018; 13:306. [PMID: 30509282 PMCID: PMC6276136 DOI: 10.1186/s13018-018-1009-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/19/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The treatment of lumbar infectious spondylitis is controversial. In this study, we attempted to demonstrate that unilateral percutaneous endoscopic debridement with physiologic saline and negative pressure drainage postoperatively may achieve a satisfactory result in lumbar infectious spondylitis. METHODS We retrospectively analyzed 17 patients with lumbar infectious spondylitis who underwent percutaneous endoscopic debridement and drainage (PEDD) through a posterolateral transforaminal approach. Each biopsy specimen was submitted without delay after surgery and examined for microorganisms and evaluated histopathologically. Patients were assessed by careful physical examination, MacNab criteria, Oswestry Disability Index (ODI), visual analog scale (VAS), regular serological tests, imaging studies for clinical function, and patient satisfaction. RESULTS Of the 17 patients, 14 (82.4%) had satisfactory relief of their back pain according to MacNab criteria at 1 week after PEDD. Three patients (17.6%) who had advanced infections with multilevel involvement and paraspinal abscesses underwent anterior debridement and autograft interbody fusion with instrumentation within 2 weeks. However, there were no other severe surgery-related complications. Causative bacteria were identified in most cases, and Staphylococcus aureus was the most prevalent strain. CONCLUSIONS Unilateral PEDD with physiological saline or empirical antibiotics did not disrupt lumbar stability and avoided the important intraspinal structures such as the dural sac and nerve roots. It not only had a high rate of identification of the causative pathogen, but also provided effective infection control and pain relief. PEDD may be a useful technique for treatment of lumbar infectious spondylodiscitis patients who have no severe deformities and are unable to undergo the conventional anterior surgery due to poor health or advanced age.
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Affiliation(s)
- Xuepeng Wang
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Shaobo Zhou
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Zhenyu Bian
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Maoqiang Li
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Wu Jiang
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Changju Hou
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Liulong Zhu
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
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