Can gas and infection coexist in the intervertebral disc? A retrospective analysis of percutaneously biopsied suspected discitis-osteomyelitis cases.
Biopsy
Gas
Infections
Spine
Spondylodiscitis
X-ray computed tomography
Journal
Skeletal radiology
ISSN: 1432-2161
Titre abrégé: Skeletal Radiol
Pays: Germany
ID NLM: 7701953
Informations de publication
Date de publication:
27 Feb 2024
27 Feb 2024
Historique:
received:
02
01
2024
accepted:
21
02
2024
revised:
20
02
2024
medline:
28
2
2024
pubmed:
28
2
2024
entrez:
27
2
2024
Statut:
aheadofprint
Résumé
To retrospectively evaluate the correlation between intradiscal gas and infection in patients percutaneously biopsied for suspected discitis-osteomyelitis. 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." 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. 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.
Identifiants
pubmed: 38413401
doi: 10.1007/s00256-024-04631-5
pii: 10.1007/s00256-024-04631-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to International Skeletal Society (ISS).
Références
Chang CY, Pelzl C, Jesse MK, Habibollahi S, Habib U, Gyftopoulos S. Image-guided biopsy in acute diskitis-osteomyelitis: a systematic review and meta-analysis. Am J Roentgenol. 2023;220:499–511.
doi: 10.2214/AJR.22.28423
Husseini JS, Habibollahi S, Nelson SB, Rosenthal DI, Chang CY. Best Practices: CT-guided percutaneous sampling of vertebral discitis-osteomyelitis and technical factors maximizing biopsy yield. AJR Am J Roentgenol. 2021;217:1057–68.
doi: 10.2214/AJR.20.24313
pubmed: 33336581
Issa K, Diebo BG, Faloon M, Naziri Q, Pourtaheri S, Paulino CB, et al. The epidemiology of vertebral osteomyelitis in the United States from 1998 to 2013. Clin Spine Surg. 2018;31:E102–8.
doi: 10.1097/BSD.0000000000000597
pubmed: 29135608
Duarte RM, Vaccaro AR. Spinal infection: state of the art and management algorithm. Eur Spine J. 2013;22:2787–99.
doi: 10.1007/s00586-013-2850-1
pubmed: 23756630
pmcid: 3843785
Skaf GS, Domloj NT, Fehlings MG, Bouclaous CH, Sabbagh AS, Kanafani ZA, et al. Pyogenic spondylodiscitis: an overview. J Infect Public Health. 2010;3:5–16.
doi: 10.1016/j.jiph.2010.01.001
pubmed: 20701886
Wang Z, Lenehan B, Itshayek E, Boyd M, Dvorak M, Fisher C, et al. Primary pyogenic infection of the spine in intravenous drug users: a prospective observational study. Spine. 2012;37:685–92.
doi: 10.1097/BRS.0b013e31823b01b8
pubmed: 22037525
Berbari EF, Kanj SS, Kowalski TJ, Darouiche RO, Widmer AF, Schmitt SK, et al. 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis Off Publ Infect Dis Soc Am. 2015;61:e26-46.
doi: 10.1093/cid/civ482
Gras G, Buzele R, Parienti JJ, Debiais F, Dinh A, Dupon M, et al. Microbiological diagnosis of vertebral osteomyelitis: relevance of second percutaneous biopsy following initial negative biopsy and limited yield of post-biopsy blood cultures. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol. 2014;33:371–5.
doi: 10.1007/s10096-013-1965-y
Govender S. Spinal infections. J Bone Joint Surg Br. 2005;87-B:1454–8.
doi: 10.1302/0301-620X.87B11.16294
An HS, Seldomridge JA. Spinal infections: diagnostic tests and imaging studies. Clin Orthop. 2006;444:27–33.
doi: 10.1097/01.blo.0000203452.36522.97
pubmed: 16523124
Modic MT, Feiglin DH, Piraino DW, Boumphrey F, Weinstein MA, Duchesneau PM, et al. Vertebral osteomyelitis: assessment using MR. Radiology. 1985;157:157–66.
doi: 10.1148/radiology.157.1.3875878
pubmed: 3875878
Ledermann HP, Schweitzer ME, Morrison WB, Carrino JA. MR imaging findings in spinal infections: rules or myths? Radiology. 2003;228:506–14.
doi: 10.1148/radiol.2282020752
pubmed: 12802004
Seller M, Burghardt RD, Rolling T, Hansen-Algenstaedt N, Schaefer C. Clostridium perfringens: a rare cause of spondylodiscitis case report and review of the literature. Br J Neurosurg. 2018;32:574–6.
doi: 10.1080/02688697.2016.1267332
pubmed: 27967243
Aghaei Lasboo A, Walker MT, Hijaz TA. An unusual appearance of discitis due to gas-forming Escherichia coli with associated pneumocephalus. Spine. 2010;35:E257-259.
doi: 10.1097/BRS.0b013e3181bca12f
pubmed: 20228705
Schömig F, Li Z, Becker L, Vu-Han T-L, Pumberger M, Diekhoff T. Gas within the intervertebral disc does not rule out spinal infection-a case series of 135 patients with spontaneous spondylodiscitis. Diagn Basel Switz. 2022;12:1089.
Yeh KJ, Husseini JS, Hemke R, Nelson SB, Chang CY. CT-guided discitis-osteomyelitis biopsies with negative microbiology: how many days should we wait before repeating the biopsy? Skeletal Radiol. 2020;49:619–23.
doi: 10.1007/s00256-019-03344-4
pubmed: 31760457
Chang CY, Simeone FJ, Nelson SB, Taneja AK, Huang AJ. Is biopsying the paravertebral soft tissue as effective as biopsying the disk or vertebral endplate? 10-year retrospective review of CT-guided biopsy of diskitis-osteomyelitis. AJR Am J Roentgenol. 2015;205:123–9.
doi: 10.2214/AJR.14.13545
pubmed: 26102390
Berns DH, Ross JS, Kormos D, Modic MT. The spinal vacuum phenomenon: evaluation by gradient echo MR imaging. J Comput Assist Tomogr. 1991;15:233–6.
doi: 10.1097/00004728-199103000-00008
pubmed: 2002100
Grenier N, Grossman RI, Schiebler ML, Yeager BA, Goldberg HI, Kressel HY. Degenerative lumbar disk disease: pitfalls and usefulness of MR imaging in detection of vacuum phenomenon. Radiology. 1987;164:861–5.
doi: 10.1148/radiology.164.3.3615888
pubmed: 3615888
Beit Ner E, Chechik Y, Lambert L-A, Anekstein Y, Mirovsky Y, Smorgick Y. Gas forming infection of the spine: a systematic and narrative review. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2021;30:1708–20.
doi: 10.1007/s00586-020-06646-7
Cianci F, Ferraccioli G, Ferraccioli ES, Gremese E. Comprehensive review on intravertebral intraspinal, intrajoint, and intradiscal vacuum phenomenon: from anatomy and physiology to pathology. Mod Rheumatol. 2021;31:303–11.
doi: 10.1080/14397595.2020.1764744
pubmed: 32374204
Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.
Fleiss JL, Levin B, Paik MC. Statistical methods for rates and proportions. 3rd ed. Hoboken: John Wiley & Sons; 2003.
Clopper CJ, Pearson ES. The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika. 1934;26:404–13.
doi: 10.1093/biomet/26.4.404
Mercaldo ND, Lau KF, Zhou XH. Confidence intervals for predictive values with an emphasis to case-control studies. Stat Med. 2007;26:2170–83.
doi: 10.1002/sim.2677
pubmed: 16927452
Feng S-W, Chang M-C, Wu H-T, Yu J-K, Wang S-T, Liu C-L. Are intravertebral vacuum phenomena benign lesions? Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2011;20:1341–8.
doi: 10.1007/s00586-011-1789-3
Libicher M, Appelt A, Berger I, Baier M, Meeder P-J, Grafe I, et al. The intravertebral vacuum phenomen as specific sign of osteonecrosis in vertebral compression fractures: results from a radiological and histological study. Eur Radiol. 2007;17:2248–52.
doi: 10.1007/s00330-007-0684-0
pubmed: 17522865
Magnusson W. Über Die Bedingungen Des Her- vortretens Der Wirklichen Gelenkspalte Auf Dem Röntgenbilde. Acta Radiol. 1937;18:733–41.
doi: 10.3109/00016923709132378
Ford LT, Gilula LA, Murphy WA, Gado M. Analysis of gas in vacuum lumbar disc. AJR Am J Roentgenol. 1977;128:1056–7.
doi: 10.2214/ajr.128.6.1056
pubmed: 414544
Ekşi MŞ, Özcan-Ekşi EE, Akkaş A, Orhun Ö, Arslan HN, Zarbizada M, et al. Intradiscal vacuum phenomenon and spinal degeneration: a cross-sectional analysis of 219 subjects. Curr Med Res Opin. 2022;38:255–63.
doi: 10.1080/03007995.2021.1994379
pubmed: 34663160
D’Anastasi M, Birkenmaier C, Schmidt GP, Wegener B, Reiser MF, Baur-Melnyk A. Correlation between vacuum phenomenon on CT and fluid on MRI in degenerative disks. AJR Am J Roentgenol. 2011;197:1182–9.
doi: 10.2214/AJR.10.6359
pubmed: 22021513
Schömig F, Palmowski Y, Nikiforov I, Hartwig T, Pumberger M, Schwabe P, et al. Burst fractures lead to a fracture-associated intervertebral vacuum phenomenon: a case series of 305 traumatic fractures of the thoracolumbar spine. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2021;30:3068–73.
doi: 10.1007/s00586-020-06590-6
Bang JH, Cho K-T. Rapidly progressive gas-containing lumbar spinal epidural abscess. Korean J Spine. 2015;12:139–42.
doi: 10.14245/kjs.2015.12.3.139
pubmed: 26512268
pmcid: 4623168
Wee LE, Hnin SWK, Xu Z, Lee LS-U. Strongyloides hyperinfection associated with Enterococcus faecalis bacteremia, meningitis, ventriculitis and gas-forming spondylodiscitis: a case report. Trop Med Infect Dis. 2020;5:44.
doi: 10.3390/tropicalmed5010044
pubmed: 32178241
pmcid: 7157694
Coulier B. The spectrum of vacuum phenomenon and gas in spine. JBR-BTR Organe Soc R Belge Radiol SRBR Orgaan Van K Belg Ver Voor Radiol KBVR. 2004;87:9–16.
Belfquih H, El Mostarchid B, Akhaddar A, Gazzaz M, Boucetta M. Sciatica caused by lumbar epidural gas. Pan Afr Med J. 2014;18:162.
doi: 10.11604/pamj.2014.18.162.1354
pubmed: 25422680
pmcid: 4239438