Vertebral Osteomyelitis

We sought to determine the concordance in frequency of microbiologic isolation and species identification in specimens obtained by 2 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.

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%.

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.

Contributions from Latin America to the global literature are scarce; until 2011, spine surgeons had published 320 articles in indexed journals.

This systematic review evaluates the scientific production of the Mexican Association of Spine Surgeons (Asociación Mexicana de Cirujanos de Columna–AMCICO) from its inception in 1998 to 2018 with the PRISMA statement using PubMed and Google Scholar search engines. The inclusion criteria were spine-related articles in indexed journals providing any (or no) level of evidence with ≥1 AMCICO member as an author. Journal metrics, article metrics, and author variables were analyzed using SPSS version 25.

Of the 444 surgeons historically belonging to AMCICO, only 126 members contributed a total of 441 articles between 1998 and 2018. An average of 21.00 annual publications with an annual scientific output per capita of 0.05 was found. The most frequent evidence level was III (211 articles, 48%), the highest level was I (12 articles, 3%). The main study objective was clinical research, with 308 articles (70%), and the main study foci was trauma, with 103 articles (23%). An average impact factor of 0.16 and 0.92 was obtained for publications in Spanish and English, respectively.

Scientific publications by AMCICO members are scarce, with a per capita annual index of 0.05 from a total of 441 articles in indexed journals. Second, the impact factor of these journals is low, with a mean value of 0.53. Further strategies should be implemented to increase the number and track the record of Mexican contributions to the scientific literature.

The main objective of the present study was to analyze the efficacy and feasibility of surgical management for patients with monosegmental lumbar or lumbosacral pyogenic vertebral osteomyelitis (PVO) by using one stage posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion.

From February 2014 to May 2016, 27 patients with lumbar or lumbosacral PVO were treated by posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion. The degree of damage to the patients' vertebral bodies was one third to one half height. There were 16 male and 11 female, with a mean age of 43.5 years (range, 32–56 years) at the time of surgery. The mean follow-up time was 35.7 months (range, 26–53 months). The clinical efficacy was evaluated on average operation time, blood loss, visual analog scale, erythrocyte sedimentation rate, C-reactive protein level, and neurologic function recovery.

PVO was completely cured and the grafted bone was fused in all 27 patients. There was no recurrent vertebral osteomyelitis infection. Erythrocyte sedimentation rate and C-reactive protein level achieved normal limits within 3 months in all patients. The American Spinal Injury Association neurologic classification was improved in all cases. Pain relief was obtained in all patients.

Our results showed that one stage posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion was an effective treatment for patients with one third to one half height of vertebral body damaged in monosegmental lumbar or lumbosacral PVO. The surgical method is characterized as minimum surgical trauma, good pain relief, good neurologic recovery, and good reconstruction of spinal stability.

In suspected spondylodiscitis and vertebral osteomyelitis, computed tomography (CT)-guided biopsies are often performed to determine a causative organism and guide antimicrobial therapy. The aim of this study is to determine the diagnostic culture yield of CT-guided biopsies performed in cases of suspected spinal infections.

A literature search of PubMed and MEDLINE up to April 2017 was performed for keywords “CT guided vertebral biopsy infection,” “CT-guided spine biopsy infection,” “CT guided spine biopsy yield,” and “CT guided vertebral biopsy yield.” Inclusion criteria primarily consisted of studies exclusively using CT-guided biopsies in cases of suspected infectious lesions only. After study selection, published articles were analysed to determine diagnostic culture yield. Descriptive statistics were applied.

220 search results were screened; 11 met our inclusion criteria and were reviewed. In total, 647 biopsies of suspected infectious spinal lesions were performed. Positive cultures were obtained in 241 cases. Upon excluding one paper's skewed results, the net pooled results culture yield was 33%. Several cultures grew multiple organisms, leading to a total of 244 species identified. Most common isolated organisms include Staphylococcus aureus (n = 83), coagulase-negative Staphylococcus (n = 45), and Mycobacteria (n = 38).

The diagnostic culture yield of CT-guided biopsies in cases of suspected spinal infection is 33%. In the majority of cases, a causative organism is not identified. This suggests that improvements can be made in biopsy technique and specimen transfer to optimize culture yield and increase the clinical value of the procedure.

Dans les cas de spondylodiscite et d'ostéomyélite vertébrale, on réalise souvent des biopsies guidées par tomodensitométrie (TDM) en vue d'identifier l'organisme causal et d'aiguiller le traitement antimicrobien. Cette étude vise à déterminer le rendement diagnostique des mises en culture à la suite de biopsies guidées par TDM dans les cas d'infections rachidiennes présumées.

Nous avons mené une recherche documentaire dans PubMed et MEDLINE jusqu'en avril 2017, en utilisant les mots clés anglais « CT guided vertebral biopsy infection », « CT-guided spine biopsy infection », « CT guided spine biopsy yield » et « CT guided vertebral biopsy yield ». Comme principal critère d'inclusion, les études devaient uniquement porter sur les biopsies guidées par TDM dans les cas de lésions infectieuses présumées. Après avoir sélectionné les études, nous avons examiné les articles publiés afin de déterminer le rendement diagnostique des mises en culture. Nous avons ensuite appliqué des méthodes de statistique descriptive.

Des 220 résultats de recherche relevés, 11 ont satisfait à notre critère d'inclusion et ont été examinés. Au total, 647 biopsies ont été pratiquées en raison de lésions rachidiennes infectieuses présumées. Parmi celles-ci, 241 ont donné lieu à des cultures positives. Le rendement net des mises en culture, calculé à partir de tous les résultats sauf ceux d'un article aux observations biaisées, s'est chiffré à 33 %. Plusieurs milieux de culture ont révélé des organismes multiples, ce qui signifie qu'au total 244 espèces ont été identifiées. Les plus courantes étaient les Staphylococcus aureus (n = 83), les staphylocoques à coagulase négative (n = 45) et les mycobactéries (n = 38).

Le rendement diagnostique des mises en culture à la suite de biopsies guidées par TDM dans les cas d'infections rachidiennes présumées est de 33 %. Dans la majorité des cas, l'organisme causal n'est pas identifié. Ce résultat suggère qu'il y a moyen d'améliorer la technique de biopsie et le transfert des prélèvements de façon à optimiser le rendement des mises en culture et à renforcer la valeur clinique de l'intervention.

La espondilodiscitis (ED) es una infección vertebral conocida desde la Antigüedad. Su incidencia está aumentando por el incremento de la expectativa de vida y de las enfermedades debilitantes. La distribución por edad es bimodal, con afectación de los menores de 20 años y de los adultos de 50-70 años. Según su origen, se clasifican en ED piógenas, granulomatosas y parasitarias, siendo las primeras las más frecuentes y ocasionadas habitualmente por Staphylococcus aureus o Escherichia coli. La presentación clínica es insidiosa, por lo que el diagnóstico puede retrasarse, sobre todo en la ED tuberculosa. Los pacientes presentan al inicio dolor espinal de tipo inflamatorio, aunque durante el curso de la enfermedad pueden tener fiebre, astenia y déficits neurológicos como complicaciones más graves. El diagnóstico se establece basándose en datos clínicos, radiológicos, de laboratorio, microbiológicos e histopatológicos. La resonancia magnética es la técnica diagnóstica de elección. El diagnóstico diferencial se realiza, entre otros procesos, con la osteocondrosis erosiva intervertebral, tumores, la espondiloartropatía axial, la espondiloartropatía de los pacientes en hemodiálisis, cambios epifisarios de Modic tipo 1 y la neuroartropatía axial de Charcot. El tratamiento se basa en erradicar la infección con antibióticos, evitar la inestabilidad espinal con fijación vertebral y eliminar el tejido infectado con un desbridamiento amplio, obteniendo muestras para análisis etiológico.

Spondylodiscitis is an infection of the spine that has been known since ancient times. Its incidence is rising, due to the increases in life expectancy and debilitating conditions. Its age distribution is bimodal, affecting persons younger than 20 years of age or persons aged 50-70 years. According to its origin, it is classified as pyogenic, granulomatous or parasitic, though the first form is the most common, usually caused by Staphylococcus aureus or Escherichia coli. The clinical presentation is insidious, resulting in a delayed diagnosis, particularly in tuberculous spondylodiscitis. The initial onset usually involves inflammatory back pain, though the disease may course with fever, asthenia and neurological deficit, these being the most severe complications. Diagnosis is based on clinical, radiological, laboratory, microbiological and histopathological data. Magnetic resonance imaging is the technique of choice for the diagnosis of spondylodiscitis. The differential diagnosis involves, among other conditions, intervertebral erosive osteochondrosis, tumour, axial spondyloarthropathy, haemodialysis spondyloarthropathy, Modic type 1 endplate changes and Charcot's axial neuroarthropathy. Treatment is based on eliminating the infection with antibiotics, preventing spinal instability with vertebral fixation, and ample debridement of infected tissue to obtain samples for analysis.