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This article comprehensively reviews current imaging concepts in spinal infection with primary focus on infectious spondylodiscitis (IS) as well as the less common entity of facet joint septic arthritis (FSA). This review encompasses the multimodality imaging appearances (radiographs, CT, MRI, and nuclear imaging) of spinal infection-both at initial presentation and during treatment-to aid the radiologist in guiding diagnosis and successful management. We discuss the pathophysiology of spinal infection in various patient populations (including the non-instrumented and postoperative spine) as well as the role of imaging-guided biopsy. We also highlight several non-infectious entities that can mimic IS (both clinically and radiologically) that should be considered during image interpretation to avoid misdiagnosis. These potential mimics include the following: Modic type 1 degenerative changes, acute Schmorl's node, neuropathic spondyloarthropathy, radiation osteitis, and inflammatory spondyloarthropathy (SAPHO syndrome)., (© 2024. The Author(s), under exclusive licence to International Skeletal Society (ISS).)

Objectives: To retrospectively evaluate the correlation between intradiscal gas and infection in patients percutaneously biopsied for suspected discitis-osteomyelitis., Materials and Methods: We retrospectively reviewed all CT-guided discitis-osteomyelitis biopsies performed between 2002 and 2022. Two independent trained musculoskeletal radiologists evaluated for presence of gas on CT and/or MRI within 1 week of the biopsy. Disagreements were resolved by a third musculoskeletal radiologist. CT was considered the gold standard for the detection of intradiscal gas. Pathology, microbiology, and imaging and clinical follow-up were used as the gold standard for presence of infection. Interrater agreement on CT and MRI, sensitivity, and positive predictive value were calculated, using the presence of gas as an indicator (test positive) for "no infection.", Results: There were 284 biopsies in 275 subjects (mean age 58 ± 1.0 (range 4-99) years; 101 (37%) females and 174 (63%) males). Of the biopsies, 12 (4%) were cervical, 80 (28%) were thoracic, 192 (68%) were lumbar, and 200 (70%) were considered true discitis-osteomyelitis based on pathology, imaging, and clinical follow-up. Interrater agreement was excellent for CT (kappa = 0.83) and poor for MRI (kappa =  - 0.021). The presence of gas had a 94% specificity and 76% negative predictive value for the absence of infection., Conclusion: CT is the preferred method for detecting intradiscal gas. The presence of gas means that discitis-osteomyelitis is unlikely. If intradiscal gas is present in the setting of discitis-osteomyelitis, the gas bubbles tend to be smaller and fewer in number., (© 2024. The Author(s), under exclusive licence to International Skeletal Society (ISS).)

Background Context: Cross-modality image generation from magnetic resonance (MR) to positron emission tomography (PET) using the generative model can be expected to have complementary effects by addressing the limitations and maximizing the advantages inherent in each modality., Purpose: This study aims to generate synthetic PET/MR fusion images from MR images using a combination of generative adversarial networks (GANs) and conditional denoising diffusion probabilistic models (cDDPMs) based on simultaneous 18 F-fluorodeoxyglucose (18F-FDG) PET/MR image data., Study Design: Retrospective study with prospectively collected clinical and radiological data., Patient Sample: This study included 94 patients (60 men and 34 women) with thoraco-lumbar pyogenic spondylodiscitis (PSD) from February 2017 to January 2020 in a single tertiary institution., Outcome Measures: Quantitative and qualitative image similarity were analyzed between the real and synthetic PET/ T2-weighted fat saturation MR (T2FS) fusion images on the test data set., Methods: We used paired spinal sagittal T2FS and PET/T2FS fusion images of simultaneous 18F-FDG PET/MR imaging examination in patients with PSD, which were employed to generate synthetic PET/T2FS fusion images from T2FS images using a combination of Pix2Pix (U-Net generator + Least Squares GANs discriminator) and cDDPMs algorithms. In the analyses of image similarity between the real and synthetic PET/T2FS fusion images, we adopted the values of mean peak signal to noise ratio (PSNR), mean structural similarity measurement (SSIM), mean absolute error (MAE), and mean squared error (MSE) for quantitative analysis, while the discrimination accuracy by three spine surgeons was applied for qualitative analysis., Results: Total of 2,082 pairs of T2FS and PET/T2FS fusion images were obtained from 172 examinations on 94 patients, which were randomly assigned to training, validation, and test data sets in 8:1:1 ratio (1664, 209, and 209 pairs). The quantitative analysis revealed PSNR of 30.634 ± 3.437, SSIM of 0.910 ± 0.067, MAE of 0.017 ± 0.008, and MSE of 0.001 ± 0.001, respectively. The values of PSNR, MAE, and MSE significantly decreased as FDG uptake increased in real PET/T2FS fusion image, with no significant correlation on SSIM. In the qualitative analysis, the overall discrimination accuracy between real and synthetic PET/T2FS fusion images was 47.4%., Conclusions: The combination of Pix2Pix and cDDPMs demonstrated the potential for cross-modal image generation from MR to PET images, with reliable quantitative and qualitative image similarities., Competing Interests: Declaration of competing interest All authors have no conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Spondylodiscitis, characterized by inflammation of the intervertebral disc and adjacent vertebral bodies, presents a diagnostic challenge due to its nonspecific clinical manifestations and variable imaging findings. This review examines the role of PET-CT with FDG, in the evaluation of spondylodiscitis, focusing on its utility in diagnosis, assessment of disease extent, treatment response monitoring, and prognostication. FDG PET-CT, by combining metabolic and anatomical imaging modalities, offers superior sensitivity and specificity compared to conventional imaging techniques in detecting infectious foci, distinguishing between infection and post-treatment changes, and identifying occult sources of infection. Additionally, FDG PET-CT facilitates the localization of infection, aiding in targeted biopsy and guiding surgical intervention. Moreover, quantitative PET parameters, such as standardized uptake values (SUVs), hold promise for predicting treatment response and prognosis. Despite its advantages, FDG PET-CT has limitations, including false-positive results in the setting of inflammation and limited availability in resource-constrained settings. Collaborative efforts between radiologists, nuclear medicine specialists, infectious disease specialists, and spine surgeons are essential to optimize the role of FDG PET-CT in the multidisciplinary management of spondylodiscitis. Further research is warranted to elucidate the cost-effectiveness and clinical impact of FDG PET-CT in this challenging clinical entity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Sonographic diagnosis of spondylodiscitis is described in a 21-month-old girl who presented with altered gait. Spondylodiscitis, also referred to as discitis-osteomyelitis, is an infection of the intervertebral disc and adjacent vertebrae. The imaging modality of choice is spinal magnetic resonance imaging. Our case is the first description in the English language of the sonographic diagnosis of spondylodiscitis. Pediatric radiologists and sonographers should be acquainted with its features, for both incidental and intentional diagnosis., (© 2024. The Author(s).)

Spinal infection comprises pyogenic and non-pyogenic spondylodiscitis. This condition may manifest with non-specific clinical symptoms, elevated infective parameters and imaging findings that are difficult to distinguish. The cornerstone of a definitive diagnosis and subsequent successful treatment lies in tissue analysis through culture and histopathological studies. In this context, we present a case of Salmonella pyogenic spondylodiscitis affecting the C5/C6 vertebrae, complicated by Salmonella bacteraemia and characterised by mechanical neck pain that curtails daily activities and overall functioning, although without neurological deficits. The uniqueness of this case stems from its occurrence in an immunocompetent individual from a non-endemic area, with no identifiable sources of Salmonella infection or preceding gastrointestinal symptoms., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Laryngectomy and pharyngectomy are surgical options for advanced laryngeal or pharyngeal squamous cell carcinoma. Cervical osteomyelitis-diskitis, occurring when there is dehiscence of the posterior neopharyngeal wall, is an uncommon complication of laryngopharyngectomy. This case series describes imaging findings of pharyngoesophageal wall breakdown with subsequent cervical spine infection and demonstrates that most of these patients had undergone prior esophageal or neopharyngeal dilations for benign posttreatment stricture. Neck pain, fever, or serologic evidence of infection should prompt careful evaluation for osteomyelitis-diskitis and assessment for neopharyngeal breakdown and sinus tract formation, especially in the postdilation setting., (© 2023 by American Journal of Neuroradiology.)

Background: Vertebral discitis-osteomyelitis (VDO) is a devastating infection of the spine that is challenging to distinguish from noninfectious mimics using computed tomography and magnetic resonance imaging. We and others have developed novel metabolism-targeted positron emission tomography (PET) radiotracers for detecting living Staphylococcus aureus and other bacteria in vivo, but their head-to-head performance in a well-validated VDO animal model has not been reported., Methods: We compared the performance of several PET radiotracers in a rat model of VDO. [11C]PABA and [18F]FDS were assessed for their ability to distinguish S aureus, the most common non-tuberculous pathogen VDO, from Escherichia coli., Results: In the rat S aureus VDO model, [11C]PABA could detect as few as 103 bacteria and exhibited the highest signal-to-background ratio, with a 20-fold increased signal in VDO compared to uninfected tissues. In a proof-of-concept experiment, detection of bacterial infection and discrimination between S aureus and E coli was possible using a combination of [11C]PABA and [18F]FDS., Conclusions: Our work reveals that several bacteria-targeted PET radiotracers had sufficient signal to background in a rat model of S aureus VDO to be potentially clinically useful. [11C]PABA was the most promising tracer investigated and warrants further investigation in human VDO., Competing Interests: Potential conflicts of interest. The authors: No potential conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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, [ 18 F]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., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Few reports have been conducted to comparing surgical results and safety evaluations between the different types of infections in geriatric patients with thoracolumbar infections. The aim of this study is to investigate the safety and efficacy of surgical treatment for thoracolumbar infections in elderly patients. 21 patients with pyogenic spondylodiscitis (PS) and 26 patients with tuberculous spondylodiscitis (TS) were enrolled in the study. All patients were treated using one-stage posterior debridement, decompression, and pedicle screw fixation. Comparison of operative safety parameters between the two groups. Clinical efficacy was evaluated using visual analogue scale (VAS) score, the American Spinal Injury Association (ASIA) grade, the short form (SF)-36 survey and Oswestry disability index (ODI) to determine patient quality of life pre- and post-operatively. Hospitalisation and intensive care unit duration in the PS group were significantly shorter than in the TS group (P < 0.05). The total incidence of post-operative complications for both groups was 44.7%. More complications occurred in the TS group, but the difference was not significant. The scores of VAS, ODI and SF-36 of all 47 patients were significantly improved compared with those before operation.The VAS and SF-36 scores (physical component) were significantly better in the PS group 6 months post-operatively, and the SF-36 (mental component) scores were significantly better in the PS group at the 1-year follow-up. Neurological status in both groups improved post-operatively, and 83% of patients reported satisfactory results based on the modified MacNab standard. Imaging results showed that bone graft fusion improved in both groups at 6 months, 1 year and at the final follow-up. One-stage posterior debridement, decompression, interbody fusion, and internal fixation can be considered a safe and effective method of treating spinal infections in the elderly. This method can improve nerve function, reconstruct spinal stability, and enhance the quality of life of elderly patients. Both PS and TS who underwent surgery achieve similar clinical and radiological results., (© 2023. The Author(s).)

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, [ 18 F]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., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Case: A 63-year-old farmer who is a known diabetic and chronic alcoholic presented with lower back pain and neurological weakness of lower limbs present for the past 3 months. His acute phase reactants were very high, and magnetic resonance imaging displayed L4-L5 vertebral involvement with epidural, paravertebral, and bilateral psoas abscesses. Cultures of an ultrasound-guided aspiration from the psoas were positive for Burkholderia pseudomallei, and a nucleic acid amplification test also detected Mycobacterium tuberculosis. He underwent posterior decompression and fixation, and intraoperative biopsy confirmed a granulomatous reaction. He received appropriate antibiotics for both diseases. At 1 year, he showed healing on radiographic imaging, with independent ambulation status., Conclusion: The coexistence of melioidosis and tuberculosis is rare, and as far as we know, a case of infective spondylodiscitis has not been reported. In patients with infective spondylodiscitis, every attempt should be made to confirm the diagnosis before starting empirical antitubercular treatment (ATT)., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C91)., (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: Spondylodiscitis is, after tissue sampling, initially managed with intravenous antibiotics. In patients with treatment failure, surgical debridement and stabilization is considered. An anterior or posterior approach has already been reported as a successful surgical access, but is associated with a large exposure and a significant morbidity., Methods: We present a multicenter Belgian case-series on the use of a minimally invasive extreme lateral interbody fusion procedure with add-on percutaneous pedicle screw fixation for patients with a need for surgical debridement and tissue samples or intractable back pain due to spondylodiscitis. Patient characteristics, microbiology results, antibiotic treatment, pre- and postoperative Visual Analogue Pain Score (VAS) scores, time to bony consolidation, complications and duration of the hospital stay were collected., Results: Seven patients with one level spondylodiscitis were included. The mean age 64 years with a mean preoperative VAS score of 8.86 ( ± 0.90). Postoperative VAS score significantly decreased to 2.57 (-70.3%, P < 0.001). Mean antibiotic treatment duration was 8 weeks. Median duration of the hospital stay was 14 days. Patients were followed for 1 year. Complete bony consolidation was observed in 6 out of 7 patients after 1 year. One patient had a stable pseudarthrosis., Conclusions: These results indicate that extreme lateral interbody fusion topped off with a percutaneous pedicle screw fixation might be a feasible, safe and valuable choice to surgically treat patients with spondylodiscitis with fast and important improvement in VAS. Further prospective research might strengthen the sparsely existing literature of minimally invasive surgery for spondylodiscitis to provide the best possible care., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Spondylodiscitis is a common referral to spinal on call services. Identification of the causative organism is vital in order to dictate the appropriate antibiotic treatment. In this context, the surgical and interventional radiology team is often asked to perform a diagnostic biopsy. The aim of the present study was to assess whether the sampling location affects the diagnostic yield. Our results suggest that the overall positive diagnostic yield was 35%. When disc material was included in the sample the diagnostic yield significantly improved to 47%. Bone sampling alone had a positive yield of 15%. Age, pre-biopsy CRP, pre-biopsy use of antibiotics did not seem to affect the likelihood of obtaining a positive yield. These results suggests that when performing image guided biopsies for suspected cases of spondylodiscitis the inclusion of disc material is important.

Objective: We sought to determine the concordance in frequency of microbiologic isolation and species identification in specimens obtained by 2 methods., Methods: Intervertebral disk specimens were taken simultaneously from each patient using percutaneous needle and posterolateral endoscopic biopsies. The isolates were reported in frequencies and concordance using the chi square and Cohen kappa tests., Results: Thirty patients were recruited. The average age was 58.1 years, and 15 patients were women. The clinical evolution time was 7 ± 4 months. The causative organism was identified in 12 (40%) specimens obtained by fluoroscopy-guided percutaneous transpedicular biopsy and in 14 (46.6%) obtained by posterolateral endoscopy. The most common organism isolated was Staphylococcus aureus in 3 patients with the percutaneous technique and in 5 with the endoscopic one; Escherichia coli was isolated in 3 patients with each method. The kappa test showed a high degree of agreement between both methods (kappa = 0.86); the agreement in bacterial species identification was 100%., Conclusions: Fluoroscopy-guided percutaneous biopsy and endoscopic sampling have a good degree of concordance for both, frequency of organism isolation and identification in patients with infectious spondylodiskitis., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background and Study Object:  Pedicle screw fixation has been widely used in surgical treatment for infective lumbar spondylodiskitis to prevent instability and deformity. The cortical bone trajectory pedicle screw (CBTPS) fixation is a minimally invasive posterior spinal fixation system that runs from the pedicle's entry point of the caudiomedial region toward the cephalad-divergent direction. Successful results with CBTPS fixation have been reported to treat degenerative and osteoporotic spinal diseases. This study aims to investigate the clinical feasibility of CBTPS in the surgical treatment of pyogenic lumbar spondylodiskitis., Patient and Methods:  We retrospectively retrieved 20 consecutive patients from two academic centers who were surgically treated for monosegmental lumbar pyogenic spondylodiskitis. The primary surgical treatment was the anterior lumbar interbody fusion with decompression, debridement, and reconstruction using an autogenous iliac strut bone graft. One to 2 weeks after the primary surgery, patients underwent a second surgery for posterior instrumentation using conventional pedicle screws (CPS; group I) and CBTPS (group II). Radiographic parameters of the deformity angle at the fusion segment and clinical parameter of visual analog scale (VAS) scores were assessed preoperatively, postoperatively, and at the last follow-up., Results:  There were 10 patients in each group. The mean follow-up periods of groups I and II were 51.10 ± 6.95 and 28.60 ± 9.31 months, respectively. Intergroup analysis indicated the two groups area age-matched ( p  = 0.38), but initial C-reactive protein (CRP; mg/dL, p  = 0.04), CRP normalization (months, p  = 0.00), and follow-up duration (months, p  = 0.00) were heterogeneous. Meanwhile, deformity angles (segmental lordosis) between the two groups were not significantly different preoperatively ( p  = 0.25), postoperatively ( p  = 0.13), and at last follow-up ( p  = 0.38). The intragroup analysis indicated a significant postoperative increase of lordosis in both group I and II ( p  = 0.00 and 0.04, respectively) with subsequent subsidence. Lordosis remained increased at the last follow-up with or without significance (group I, p  = 0.02; group II, p  = 0.62). Both groups showed significant improvement in VAS scores (group I, p  = 0.00; group II, p  = 0.00)., Conclusion:  In monosegmental lumbar spondylodiskitis, posterior stabilization of the anterior strut bone graft by CBTPS and CPS was comparable via the radiographic parameter of segmental lordosis or deformity angle. Our observation suggests the clinical feasibility of CBTPS in the treatment of relatively mild monosegmental pyogenic lumbar spondylodiskitis., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Subaxial cervical spine spondylodiscitis represents a real challenge in spine surgery. In later stages multiple spinal metamers can the interested by the pathological infection and the alteration of the spinal stability leading to spinal deformity. There is scant literature on subaxial cervical spondylodiscitis management and especially on ≥three-level cervical corpectomies. The authors conducted a literature search on this specific topic and presented an emblematic case of a patient treated with circumferential cervical fixation and four-level cervicothoracic corpectomy., Materials and Methods: A comprehensive literature review was performed using the combined Medical Subject Headings (MeSH) terms (multilevel) AND (sub axial spine OR cervical spine) AND (spine osteomyelitis OR spinal osteomyelitis), to search in the PubMed and Scopus databases. Our case was also included in this literature review. From our literature search the authors selected 13 papers, eight were excluded because they did not match our inclusion criteria (the involvement of only one or two levels, or did not perform corpectomy, discectomy, or cervical spine localization). The authors also presented a 71-year-old patient, in poor general clinical status who underwent several cage repositioning, with a final four-level corpectomy (C5, C6, C7, and T1), expandable C5-T1 cage positioning and C4-T2 anterior plating performed merging augmented reality, neuronavigation and intraoperative imaging., Results: This systematic review included 28 patients treated with ≥ three-level corpectomy (11 patients with three-level corpectomy, 15 patients with four-level corpectomy, and 2 patients with six-level corpectomy), 6 women, 5 men, and 17 not reported specifically, with a mean age of 55.9 years (range: 44-72 years). The combined anterior and posterior approach was taken in all but one case, which was treated with the anterior approach only. In one case of six-level cervicothoracic corpectomy, sternotomy was necessary. All reported patients recovered after surgery, except one who died after nosocomial pneumonia. No major intraoperative complications were reported. Usual postoperative complications include wound hematoma, pneumonia, subsidence, epidural hematoma, dural leakage, dysphagia, soft tissue swelling. The mean follow-up time was 31.9 months (range: 8-110 months)., Conclusion: According to the literature search performed by the authors, multilevel corpectomies for cervical spinal osteomyelitis is a safe and effective complex surgical procedure, even in extended procedures involving up to six levels or those at the cervicothoracic junction. The use multimodal navigation merging intraoperative imaging acquisition, navigation, and augmented reality may provide useful information during implant positioning in complex and altered anatomy and for assessing the best final result., (© 2023. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

Background and Study Aims:  Spinal instrumentation for spondylodiskitis (SD) remains highly controversial. To date, surgical data are limited to relatively small case series with short-term follow-up data. In this study, we wanted to elucidate the biomechanical, surgical, and neurologic long-term outcomes in these patients., Material and Methods:  A retrospective analysis from two German primary care hospitals over a 9-year period (2005-2014) was performed. The inclusion criteria were (1) pyogenic lumbar SD, (2) minimum follow-up of 1 year, and (3) surgical instrumentation. The clinical and radiologic outcome was assessed before surgery, at discharge, and at a minimum of 12 months of follow-up. Follow-up included physical examination, laboratory results, CT and MRI scans, as well as assessment of quality of life (QoL) using short-form health survey (SF-36) inventory, Oswestry Disability Questionnaire, and visual analog scale (VAS) spine score., Results:  Complete data were available in 70 patients (49 males and 21 females, with an age range of 67±12.3 years) with a median follow-up of 6.6 ± 4.2 years. Follow-up data were available in 70 patients after 1 year, in 58 patients after 2 years, and in 44 patients after 6 years. Thirty-five patients underwent posterior stabilization and decompression alone and 35 patients were operated on in a two-stage 360-degree interbody fusion with decompression. Pre- and postoperative angles of the affected motion segment were 17.6 ± 10.2 and 16.1 ± 10.7 degrees in patients with posterior instrumentation only and 21.0 ± 10.2 and 18.3 ± 10.5 degrees in patients with combined anterior/posterior fusion. Vertebral body subsidence was seen in 12 and 6 cases following posterior instrumentation and 360-degree instrumentation, respectively. Nonfusion was encountered in 22 and 11 cases following posterior instrumentation and 360-degree instrumentation, respectively. The length of hospital stay was 35.0 ± 24.5 days. Surgery-associated complication rate was 18% (12/70). New neurologic symptoms occurred in 7% (5/70). Revision surgery was performed in 3% (2/70) due to screw misplacement/hardware failure and in 3% (2/70) due to intraspinal hematoma. Although patients reported a highly impaired pain deception and vitality, physical mobility was unaffected and pain disability during daily activities was moderate., Conclusion:  Surgical treatment of SD with a staged surgical approach (if needed) is safe and provides very good long-term clinical and radiologic outcome., Competing Interests: None declared., (Thieme. All rights reserved.)

The prevalence of nonspecific pyogenic spondylodiskitis, associated with both a high morbidity and a high mortality, has increased in the last few decades. The diagnosis is often delayed because of the nonspecific clinical manifestation at the early stage. The reliability of radiographs is limited, particularly in early stage after the onset of infection. Computed tomography (CT) can reliably assess the bony condition with the possibility of spatial visualization. Contrast enhancement supports the detection of affected soft tissue. Magnetic resonance imaging (MRI) continues to be the gold standard in the diagnosis of spondylodiskitis. Sophisticated investigation protocols supported by gadolinium enhancement secure the diagnosis. MRI has a high resolution without radiation exposure. Different nuclear investigation techniques extend the diagnostic options. Reports of 18F-fluorodeoxyglucose-positron emission tomography (18-FDG-PET) are particularly promising to confirm the diagnosis. The drawback of the reduced image quality with respect to detailed anatomical information can be overcome by a combined simultaneous acquisition of CT or MRI. With respect to one of the greatest challenges, the differentiation between degenerative changes (Modic type 1) and infection at an early stage using differentiated MRI protocols and FDG-PET is promising. This overview presents a concise state-of-the-art look at radiologic investigations in case of suspected nonspecific pyogenic spondylodiskitis with the focus on a pragmatic approach., Competing Interests: None declared., (Thieme. All rights reserved.)

Background:  Lower back pain is a frequent cause of emergency department visits and one of the leading causes of the disease burden worldwide. The purpose of this case report and literature review was to discuss atypical abdominal entities mimicking spinal diseases typically presenting with lower back pain., Methods:  A 79-year-old man presented with lower back pain and urinary incontinence after receiving a non-image-guided lumbar infiltration treatment 4 weeks prior to admission. The magnetic resonance imaging (MRI) highlighted multisegmental hyperintensities in the intervertebral disk spaces of the lumbar spine indicative for spondylodiscitis. Antibiotic treatment over a week did not lead to significant clinical improvement. Blood cultures, cardiologic, otorhinolaryngologic, and dental examinations turned out negative for a focus of infection. A computed tomography (CT) guided biopsy was indicated after discontinuation of antibiotic treatment for less than 24 hours. Rapid clinical deterioration with concomitant onset of abdominal pain resulted in the diagnosis of cholecystitis, which required cholecystectomy. We performed a systematic literature review using the Pubmed database for the keywords "spondylodiscitis," "spine," "abdominal," and "cholecystitis," to identify abdominal diseases that mimic spine pathologies and spinal diseases that mimic abdominal pathologies., Results:  No other report in English literature of cholecystitis associated with initial onset of lower back pain was identified. Eighteen reports referred to abdominal conditions that mimic spinal diseases, among them a patient with cyclic lumbar back pain who received a lumbar spinal fusion who, after persisting symptoms led to further diagnostic procedures, was ultimately diagnosed with endometriosis. Spinal symptoms included paraplegia and urinary incontinence as results of acute aortic pathologies. Eleven reports presented spinal pain mimicking abdominal conditions including abdominal pain and diarrhea as well as have had surgical procedures such as an appendectomy before the spinal condition was discovered., Conclusion:  Clinical symptoms of the spine such as lower back pain can be unspecific and lead to false conclusions in the presence of concomitant pathologies in MRI. Only clinical deterioration in our case patient prompted correction of the diagnosis on day 7. Initial workup for alternative common infectious foci such as lung and urinary tract was performed, but further abdominal workup despite the absence of abdominal symptoms may have led to an earlier diagnosis. Our literature review found several cases of misdiagnosed spinal and abdominal conditions. Some had undergone unnecessary surgical procedures before the right diagnosis was made. Because of the high incidence of symptoms such as lumbar back pain and abdominal pain, considering optimal patient care as well as economic aspects, it would be essential to conduct an interdisciplinary clinical management to avoid errors in the early stage of diagnostics., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Human brucellosis is the most frequently contracted zoonotic infection worldwide. Although being an old disease that carries minimal risks of mortality, it remains a source of considerable sequelae and disability. However, noncontiguous multifocal spinal involvement is an exceptional presentation of brucellosis; additionally, an associated paravertebral abscess is extremely rare., Case Presentation: This paper focuses on a 67-year-old Lebanese woman with noncontiguous multifocal Brucella spondylodiscitis, involving the T12-L1 and L3-L4 segments, with paravertebral abscess formation. She presented with a 3-week history of acute severe lumbar back pain, radiating to the lower extremities and associated with impaired mobility and lower extremity weakness. The patient complained of night sweating but had no fever. No lymphadenopathy, hepatomegaly, or splenomegaly could be observed. She had painful percussion of the lumbar spine, painful passive mobilization, and paravertebral tenderness, yet her neurological examination was completely normal. BrucellaCapt test was positive at a titer of 1/5120 (reference range 1/180). The patient was treated with an inpatient regimen for 2 weeks, which was followed by an outpatient oral antibiotic regimen with doxycycline, rifampin, and ciprofloxacin to complete a total treatment duration of 3 months. Magnetic resonance imaging was performed at the end of the treatment and showed a complete resolution of the paravertebral abscess., Conclusion: Noncontiguous multifocal Brucella spondylodiscitis with paravertebral abscess is an extremely rare presentation. It may be effectively managed by antibiotic therapy, without surgery or drainage, in the absence of neurological complications. Nonetheless, the principal challenge to an efficient management is establishing the diagnosis of Brucella in the first place. In endemic countries, a strong suspicion of spinal involvement of brucellosis should be elicited in front of back pain presentations-even in the absence of fever and other related symptoms., (© 2022. The Author(s).)

Background: Computed tomography (CT) findings of dogs with discospondylitis have not been widely described despite increased availability of this imaging modality., Objectives: Describe the CT features of discospondylitis in a population of clinically affected dogs with discospondylitis diagnosed by magnetic resonance imaging (MRI)., Animals: Forty-one dogs (63 affected discs) with MRI-identified discospondylitis presented to a single referral hospital between 2012 and 2022., Methods: Retrospective, single center, descriptive case series with analysis of MRI-identified discospondylitis sites and concomitant CT imaging. Computed tomographic features of MRI-affected sites including intervertebral disc space (IVDS), endplates, vertebral body, epidural space and paraspinal tissues were described., Results: The most frequently found changes were: (1) endplate involvement (87.3%) most frequently bilateral (94.5%), with erosion (61.9%) and multifocal osteolysis (67.3%); (2) periosteal proliferation adjacent to the IVDS (73%) and spondylosis (66.7%); and (3) vertebral body involvement (66.7%) involving one-third of the vertebra (85.7%) with multifocal osteolysis (73.5%). Other less prevalent features included an abnormal IVDS (narrowed or collapsed), sclerosis of the adjacent vertebral body or endplates, presence of disseminated idiopathic skeletal hyperostosis or vacuum artifact., Conclusions and Clinical Importance: We determined that bilateral endplate erosion and periosteal proliferation were very common in dogs with discospondylitis. Careful evaluation of CT in all 3 planes (dorsal, sagittal, transverse) is necessary to identify an affected IVDS. These described CT features can aid in the diagnosis of discospondylitis in dogs but equivocal cases might still require MRI., (© 2022 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Paediatric spondylodiscitis (SD) (discitis) is a rare bacterial infection involving the inter-vertebral disc space and adjacent vertebrae. The non-specific manifestations of SD can lead to delayed diagnosis, which may ultimately result in spinal deformities and even devastating neurological complications. The main purpose of this review is to discuss the epidemiology, clinical, laboratory and radiological features, management and outcome of paediatric SD to help paediatricians recognise and treat this important condition., (© 2022 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Background and Purpose: Percutaneous tissue biopsy is a key step in the diagnosis and management of spondylodiscitis, often utilizing CT-guided bone biopsy or fluoroscopic-guided disc aspirations. Our objective was to compare radiation exposure, procedure time, sedation requirement & yield between the two modalities., Materials and Methods: 103 patients in 2 cohorts underwent fluoroscopic-guided disc aspirations (n = 47) or CTguided bone biopsy (n = 46) for diagnosis of spondylodiscitis. Patient and imaging data were gathered to ensure matched cohorts. Interventional and post-procedural data included radiation exposure, procedure time, complications, and microbiological details. Yield was calculated using MRI findings as the gold standard for infection., Results: There were no significant differences between cohorts in demographics, symptom duration, or pre-procedure antibiotics use. CT-guided bone biopsy required more general anesthesia (26% vs 0%, P < 0.001), had longer radiation exposure time (60 ± 24s vs 2 ± 3s, P < 0.001), radiation dose (114.4 ± 71.6 mGy vs 70.4 ± 147.2 mGy), and procedure time (62 ± 14m vs 31 ± 23m, P < 0.001) than fluoroscopic-guided disc aspirations. There was no significant difference in yield (34% vs 32%, P = 0.661), and it was not affected by antibiotic use., Conclusions: Both modalities have similar utility in isolating causative organisms in suspected cases of spondylodiscitis. Our results suggest that increased radiation exposure, longer procedure time, and increased anesthesia use are relative disadvantages of CT-guided biopsy without an increase in yield. Controlled trials may be beneficial in determining the optimal choice in different scenarios., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: Our aim was to assess the role of computed tomography (CT) or magnetic resonance imaging (MRI) in the assessment of spondylodiscitis, identifying the best target structures for biopsy to increase the likelihood of positive cultures., Materials and Methods: This study was approved by our Institutional Review Board, and requirement for specific consent form was waived. In this retrospective single Institution study, we evaluated clinical and imaging records of 60 patients who underwent spine biopsy for suspected spondylodiscitis from January 2016 to May 2021. CT and MRI sensitivity and inter-reader agreement were assessed according to the phase of spondylodiscitis, defined as acute, subacute or chronic. Inter-reader agreement for the diagnosis and identification of spondylodiscitis phase was assessed using K statistics. Univariate logistic regression analysis was performed to assess any relationship between MRI/CT findings, spondylodiscitis phase and positive cultures., Results: Sixty patients (48 males) with mean age 59, 2 ± 29 were enrolled in this study. MRI showed higher sensitivity (96% vs 65% of CT) in the diagnosis and good inter-reader agreement (k = 0.8) in the identification of the acute and subacute phase of spondylodiscitis, and moderate inter-reader agreement (k = 0.7) and lower sensitivity (80% vs 95% of CT) for the chronic phase. Univariate analysis showed as MRI-specific findings such as extensive hyperintensity of vertebral body and/or disc on Short Tau Inversion Recovery-T2w images, paravertebral collections, preserved or augmented disc height and presence of a vertebral fractures were mainly found in the acute/subacute phase and was a predictor for positive cultures (p < 0.05)., Conclusion: MRI and CT are both able to identify the different phases of spondylodiscitis, although MRI is more sensitive in the acute phase. Findings such as extensive hyperintensity of the disc/vertebral body, fractures and paravertebral collections, represent the main targets for biopsy related to a positive culture., (© 2022. Italian Society of Medical Radiology.)

Background: This retrospective study analyzed the clinical characteristics and outcomes of patients with anaerobic spondylodiscitis., Methods: From a total of 382 patients with infectious spondylodiscitis, nine patients (2.4%; two male and seven female with an average age of 67 years) with anaerobic spondylodiscitis between March 2003 and March 2017 were analyzed., Results: Most of the patients (77.8%) initially presented with afebrile back pain. Hematogenous spread occurred in seven patients and postoperative infection in two patients. Bacteroid fragilis was the most common pathogen isolated from three patients. Atypical radiographic characteristics, including a vertebral fracture with the preservation of disk height or coexisting spondylolytic spondylolisthesis, occurred in four patients with hematogenous anaerobic spondylodiscitis. The eradication rate of anaerobic infection was significantly higher in the patients with hematogenous infection than in those with postoperative infection (100% vs. 0%, p = 0.0476). Anaerobic spondylodiscitis accounted for 2.4% of cases of infectious spondylodiscitis and predominantly affected the female patients., Conclusions: Diagnostic delay may occur because of atypical spinal radiographs if the patient reports only back pain but no fever. Anaerobic infection following elective spinal instrumentation has a higher recurrence rate., (© 2022. The Author(s).)

Background/objective: Contrast-enhanced magnetic resonance imaging (MRI) is the preferred imaging modality for diagnosing pyogenic spinal infection (PSI), but it is not always available. Our objective was to describe pyogenic spinal infection imaging characteristics in patients presenting to a community emergency department (ED) and estimate the computed tomography (CT) sensitivity for these infections., Methods: We examined the MRI reports from a cohort of 88 PSI patients whom we enrolled in a prospective cohort study and report the prevalence of each PSI type (spinal epidural abscess/infection, vertebral osteomyelitis/discitis, septic facet, and paravertebral abscess/infection) according to contemporary nomenclature. In a 14 patient subcohort who underwent both CT and MRI studies, we report the sensitivity for each PSI from a post hoc blinded overread of the CT imaging by a single neuroradiologist., Results: Of the 88 PSI patients, the median age was 55 years, and 31% were female. The PSI prevalence included: spinal epidural abscess/infection (SEA) in 61(69%), vertebral osteomyelitis/discitis (VO/D) in 54 (61%), septic facet (SF) in 15 (17%), and paravertebral abscess/infection (PVA) in 53 (60%). Of the SEAs, 82% (50/61) were associated with other spinal infections, while 18% (11/61) were isolated SEAs. The overall CT sensitivity in a masked overread was 79% (11/14) for any PSI, 83% (10/12) for any infection outside the spinal canal, and only 18% (2/11) for SEA., Conclusion: Patients found to have vertebral osteomyelitis/discitis, septic facet, and paravertebral infections frequently had a SEA coinfection. CT interpretation by a neuroradiologist had moderate sensitivity for infections outside the spinal canal but had low sensitivity for SEA., Competing Interests: Declaration of Competing Interest SS, GB, MDA, BL, SM, and WTD report no funding, grants or conflicts of interest for this research., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The diagnosis of acute spondylodiscitis can be very difficult because clinical onset symptoms are highly variable. The reference examination is MRI, but very often the first diagnostic investigation performed is CT, given its high availability in the acute setting. CT allows rapid evaluation of other alternative diagnoses (e.g., fractures), but scarce literature is available to evaluate the accuracy of CT, and in particular of multi-detector computed tomography (MDCT), in the diagnosis of suspected spondylodiscitis. The aim of our study was to establish MDCT accuracy and how this diagnostic method could help doctors in the depiction of acute spondylodiscitis in an emergency situation by comparing the diagnostic performance of MDCT with MRI, which is the gold standard., Methods: We searched our radiological archive for all MRI examinations of patients who had been studied for a suspicion of acute spondylodiscitis in the period between January 2017 and January 2021 ( n = 162). We included only patients who had undergone MDCT examination prior to MRI examination ( n = 25). The overall diagnostic value of MDCT was estimated, using MRI as the gold standard. In particular, the aim of our study was to clarify the effectiveness of CT in radiological cases that require immediate intervention (stage of complications). Therefore, the radiologist, faced with a negative CT finding, can suggest an elective (not urgent) MRI with relative serenity and without therapeutic delays., Results: MDCT allowed identification of the presence of acute spondylodiscitis in 13 of 25 patients. Specificity and positive predictive value were 100% for MDCT, while sensitivity and negative predictive value were 68% and 50%, respectively, achieving an overall accuracy of 76%. In addition, MDCT allowed the identification of paravertebral abscesses (92%), fairly pathognomonic lesions of spondylodiscitis pathology., Conclusions: The MDCT allows identification of the presence of acute spondylodiscitis in the Emergency Department (ED) with a satisfactory accuracy. In the case of a positive CT examination, this allows therapy to be started immediately and reduces complications. However, we suggest performing an elective MRI examination in negative cases in which pathological findings are hard to diagnose with CT alone.

Purpose: MRI is currently the gold standard imaging modality in the diagnosis of lumbar spine discitis/osteomyelitis. However, even with supportive clinical and laboratory data, the accuracy of MRI remains limited by several degenerative and inflammatory mimics, such that it continues to represent a challenge for radiologists. This study reports a new quantitative imaging marker of lumbar paraspinal soft tissue edema which shows significant accuracy for spondylodiscitis., Methods: Thirty-five patients with equivocal MRI findings of lumbar discitis/osteomyelitis vs endplate degenerative changes were reviewed over a 24-month period. Patients with a history of surgery, fractures/recent trauma, signs of advanced infection such as abscesses, phlegmon or severe osseous destruction were excluded. Two ABR board certified neuroradiologists who were blinded to the final diagnosis evaluated a new marker; the superior-inferior paraspinal edema ratio (SI-PER). The SI-PER was obtained by measuring the superior-inferior extent of increased signal/edema in the paraspinal soft tissues on the paraspinal inversion recovery images divided by the vertebral body height measured at midpoint. Cases positive for spondylodiscitis were those confirmed by biopsy, aspiration/drainage, surgery, or clinical improvement following antibiotic treatment. The diagnostic sensitivity and specificity of SI-PER were determined by Receiver operating characteristic (ROC) analysis., Results: In 23/35 (66%) patients, the diagnosis of discitis/osteomyelitis was confirmed. The SI-PER showed a significant association with a positive MRI diagnosis (p = 0.001). Inter-observer correlation for SI-PER was 0.92. ROC analysis showed an area under the curve of 0.84. A SI-PER of 2.5 was 96% sensitive and 75% specific for the diagnosis of discitis/osteomyelitis, with a PPV of 88% and a NPV of 90%., Conclusion: In this study, the superior inferior paraspinal edema ratio (SI-PER), a newly defined MRI marker, was found to have high sensitivity for differentiating spondylodiscitis from endplate degenerative changes on lumbar spine MRI., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: To identify the diagnostic yield and predictive factors for microbiological diagnosis in patients with spondylodiscitis through computed tomography (CT)-guided biopsy or aspiration., Materials and Methods: A retrospective review of 102 patients with suspected spondylodiscitis who underwent CT-guided procedures in an 8-year period was conducted. Analyzed variables were demographic data, C-reactive protein, pre-biopsy MRI findings, prior antibiotic use, site of biopsy/aspiration, histopathological findings, culture results and radiation dose., Results: The culture yield among all sites was 56%, 85.6% for paravertebral/discal fluid aspiration, 66.7% for disk-only biopsy, 52.9% for paravertebral soft tissue biopsy, and 39.6% for endplate bone-disk unit. Patients with paravertebral/disk collection on MRI had better yields when submitted to fluid aspiration instead of biopsy of other sites (78.9% vs. 36.6%; p = 0,006). Pyogenic etiology corresponded to 68.3% of cases and Staphylococcus aureus was the most common agent. Prior antibiotics exposure was associated with a lower yield (66.2% vs. 40.9%, p = 0,016)., Conclusions: CT-guided procedures are safe and well-tolerated in patients with suspected spondylodiscitis, with good microbiologic yield particularly in the presence of paravertebral/discal abscess., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)

Purpose: Even though spinal infections are associated with high mortality and morbidity, their therapy remains challenging due to a lack of established classification systems and widely accepted guidelines for surgical treatment. This study's aim therefore was to propose a comprehensive classification system for spinal instability based on the Spinal Instability Neoplastic Score (SINS) aiding spine surgeons in choosing optimal treatment for spontaneous spondylodiscitis., Methods: Patients who were treated for spontaneous spondylodiscitis and received computed tomography (CT) imaging were included retrospectively. The Spinal Instability Spondylodiscitis Score (SISS) was developed by expert consensus. SINS and SISS were scored in CT-images by four readers. Intraclass correlation coefficients (ICCs) and Fleiss' Kappa were calculated to determine interrater reliabilities. Predictive validity was analyzed by cross-tabulation analysis., Results: A total of 127 patients were included, 94 (74.0%) of which were treated surgically. Mean SINS was 8.3 ± 3.2, mean SISS 8.1 ± 2.4. ICCs were 0.961 (95%-CI: 0.949-0.971) for total SINS and 0.960 (95%-CI: 0.946-0.970) for total SISS. SINS yielded false positive and negative rates of 12.5% and 67.6%, SISS of 15.2% and 40.0%, respectively., Conclusion: We show high reliability and validity of the newly developed SISS in detecting unstable spinal lesions in spontaneous spondylodiscitis. Therefore, we recommend its use in evaluating treatment choices based on spinal biomechanics. It is, however, important to note that stability is merely one of multiple components in making surgical treatment decisions., (© 2022. The Author(s).)

The aims of this study were to investigate the outcomes of low- and high-virulence bacterial cervical intervertebral discs (IVDs) infection and its association with cervical IVDs degeneration in rats. A total of 75 clean grade male rats were used to establish the corresponding animal models of low and high virulent bacterial cervical disc infection via an anterior cervical approach, with injection of Propionibacterium acnes (P. acnes) and Staphylococcus epidermidis (S. epidermidis) with a 29 G needle to cervical IVDs. Specimens were collected for evaluation of Blood routine (Blood-RT), histological staining, and gene expression assays after a magnetic resonance imaging (MRI) scan. There were no statistical differences in all groups in white blood cells (WBC) at 2 and 6 weeks postoperatively (P = 0.136). The highest percentage of neutrophils was found in the S. epidermidis group at 2 weeks postoperatively (P = 0.043). MRI and histology showed that at 6 weeks postoperatively, the puncture group and P. acnes group had similar disc degeneration. In the S. epidermidis group, the disc and subchondral bone structure had been destroyed and bony fusion had occurred after the discitis. The upregulation of pro-inflammatory factor expression had the strongest effect of S. epidermidis on the early stage, while the upregulation in the puncture and P. acnes groups was more persistent. P. acnes infection of the cervical IVDs can lead to degenerative changes, whereas S. epidermidis infection leads to the manifestation of septic discitis. The correlation between P. acnes infection and cervical IVDs degeneration found in clinical studies was confirmed.

Background: Veillonella species are an opportunistically pathogenic commensal anaerobic Gram-negative coccus commonly found in the oral, genitourinary, respiratory, and intestinal tract of humans and some animals. Infection is rare, even in immunocompromised hosts, and has been identified to cause a wide array of different infections, including endocarditis, osteomyelitis, and meningitis., Case Presentation: An 82-year-old Caucasian male retired ex-gymnast presented to the emergency department with a 2-week history of acute on chronic lower back pain without clear precipitant. He displayed no systemic symptoms, and had not sustained any recent injuries. Initial blood and radiological investigation did not reveal an infective or mechanical cause for his pain; however, a few days into admission, he developed a fever and signs of sepsis. A thorough septic screen was performed, including a spinal magnetic resonance imaging scan, which did not reveal any abnormalities. Blood cultures revealed Veillonella parvula bacteremia, with subsequently repeated magnetic resonance imaging displaying rapid disseminated infection including bilateral psoas abscess, discitis, and osteomyelitis. Infective endocarditis was later identified with echocardiogram. He received intravenous ceftriaxone and later oral amoxicillin and clavulanic and recovered on 6-month follow-up., Conclusions: This case illustrates the potential pathogenicity and unexpected rapid course of Veillonella parvula infection even in an immunocompetent host presenting with back pain. This case highlights the critical importance of a thorough septic screen when investigating patients for early signs of sepsis., (© 2022. The Author(s).)

Background: Various surgical techniques for treating spondylodiscitis have been proposed, but the optimal surgical treatment remains controversial. In this study, we propose a new procedure that is implanting antibiotic-loaded calcium sulfate (CS) beads into the disc after debridement using the Quadrant channel combined with percutaneous fixation through a single-stage posterolateral approach for the treatment of spondylodiscitis. Thus, the purpose of this study is to assess the safety and efficacy of this procedure., Methods: This study collected the data of 32 patients with spine spondylodiscitis and was surgically treated in our department from July 2015 to August 2020. The Demographic data included age, gender, involved segment, and complications were collected. The intra-operative details, results of culture, functional outcome, radiologic outcome, and length of hospital stay, laboratory examination were recorded., Results: The mean age of the 32 patients was 61.1 ± 9.7 years old. The mean operative time was 135.0 ± 30.6 minutes, and the mean blood loss was 243.4 ± 92.1 ml. The positive rate of culture was 72%. The mean Visual analogue scale (VAS) and Oswestry Disability Index (ODI) score significantly improved from 7.5 to 1.6 and from 65% to 10%. Cobb angle was significantly improved and could be maintained at final follow-up. New bone formation was observed in all patients. There were no recurrences of infection in our study., Conclusions: The posterolateral debridement and percutaneous fixation combined with antibiotic-loaded calcium sulfate beads filling are effective in the treatment of spondylodiscitis in terms of infection control, early mobilization, and recovery., (© 2022. The Author(s).)

Spondylodiscitis is an infectious process that requires numerous health care professionals to be clearly diagnosed and eventually successfully treated. It implies a variety of microbiological agents and conditions; during the diagnostic workup, it is difficult to correctly identify them, and the clinician has to rapidly choose the correct treatment to avoid permanent injuries to the patient. In this context, we conducted a review to better understand the most suitable use of Positron Emission Tomography with 18-Fluoro-deossi-glucose (FDG PET) in a patient suspected of spondylodiscitis, based on current guidelines and literature.. We wanted to review the role of FDG PET in the spondylodiscitis diagnosis and follow up in the context of the current guidelines., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objective: The aim of this study was to assess the magnetic resonance imaging (MRI) features associated with microbial pathogen detection by computed tomography (CT)-guided biopsy in patients with suspected septic spondylodiscitis., Methods: For the last 10-year period, we analyzed the medical records of patients who underwent MRI and CT-guided biopsy for suspected septic spondylodiscitis. Clinical characteristics were recorded. The following MRI features were assessed: edema or contrast enhancement of the intervertebral disc, adjacent vertebrae, epidural and paravertebral space, presence of abscess, and paravertebral edema size. A positive biopsy was defined by pathogen identification on bacterial analysis or the presence of granuloma on histology. Predictors of a positive biopsy were assessed with a logistic regression model., Results: We examined data for 61 patients (34 [56%] male; mean age, 59.9 ± 18.0 years); for 35 patients (57%), CT-guided biopsy was positive for a pathogen. The 4 MRI findings significantly associated with a positive biopsy were epiduritis, greater than 50% vertebral endplate edema, loss of intradiscal cleft, and abscess. The size of paravertebral edema was greater with a positive than negative biopsy (median, 15.9 [interquartile range, 11.3-21.3] vs 7.3 [4.6-12.9] mm; p = 0.004). On multivariable analysis, epiduritis was the only independent predictor of a positive biopsy (adjusted odds ratio, 7.4 [95% confidence interval, 1.7-31.4]; p = 0.006)., Conclusions: Epiduritis and the size of paravertebral edema on MRI are associated with detection of a microbial pathogen in suspected septic spondylodiscitis. For patients without these MRI signs, the need for further investigations such as enriched or prolonged cultures, a second CT-guided biopsy, or even surgical biopsy need to be discussed., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Use of BMP in the setting of infection remains controversial. We examined the safety and effectiveness of BMP in the surgical treatment of pyogenic spondylodiscitis and compared patients who have been treated with or without BMP during surgery., Methods: 57 patients who have undergone surgery for pyogenic spondylodiscitis after presenting to a tertiary Spine referral institution between 2011 and 2020 were included. 18 underwent surgery alone without BMP and 39 underwent surgery with BMP. Outcomes were compared between the two groups, including re-operations, infection recurrences, BMP- related complications and radiological fusion., Results: The cohort comprised 41 males (71.9%) with a mean age 63.7 +/- 13.3 years. Surgical indications include instability (n = 18), pain (n = 4), neurological deficit (n = 15) and sepsis or failure of non-operative management (n = 20). In the group who underwent surgery without BMP, there were two cases of re-operation for infection recurrence (11.1%) and three cases of cage subsidence; 80% achieved definitive and probable fusion. In the group who underwent surgery with BMP, there were three cases of re-operation for infection recurrence (7.7%), three cases of cage subsidence and one case of BMP- related radiculitis; 96.5% achieved definitive and probable fusion., Conclusions: The use of BMP in the surgical treatment of pyogenic spondylodiscitis did not confer an increased risk of infection recurrence, revision surgery or radiculitis. BMP can be a useful and safe adjunct in surgical intervention for pyogenic spondylodiscitis., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Aim: To reveal the efficiency of our surgical approach algorithm in patients with thoracolumbar pyogenic spondylodiscitis based on the involvement of anatomical structure., Material and Methods: Data of patients who underwent debridement or stabilization surgery for thoracolumbar pyogenic spondylodiscitis from January 2012 to December 2018 were reviewed. Lumbar and thoracolumbar spondylodiscitis was classified into four stages based on anatomical involvement. Infection was limited in the disc space, which had not spread to the endplate in stage 1 and progressed as two-level corpus involvement of > 1/2 of vertebral corpus bony destruction or as failed treatment in stage 4. Neurological function was evaluated using Frankel's grading postoperatively. Functional outcomes were categorized according to the Kirkaldy-Willis criteria., Results: The study included 39 patients, with a mean age of 58.2 years. Of these patients, 10, 12, 13, and 4 had stages 1, 2, 3, and 4 spondylodiscitis, respectively. The mean follow-up period was 60.2 (12-184) months. All patients with stages 1 and 2 spondylodiscitis had grade E injury; 2 and 10 patients with stage 3 had grades D and E injuries, respectively; two patients with stage 4 had grade D injury and two had grade E injury at the last follow-up. Moreover, 100%, 84.6%, and 50% of the patients with stages 1 and 2, 3, and 4 spondylodiscitis achieved good or excellent results, respectively., Conclusion: The choice of the surgical technique depends on the destruction severity at the adjacent vertebral corpus. Surgical staging system for spondylodiscitis is useful and reliable in choosing appropriate surgical techniques.