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Clinical and Radiological Features Predicting Intervertebral Autofusion after Successful Antibiotic Therapy in
Insu Seong1, Eunjung Kong2, Ikchan Jeon1
1Department of Neurosurgery, Yeungnam University College of Medicine, Daegu 42415, Korea.
Background:
Pyogenic vertebral osteomyelitis (PVO) is a bacterial infection involving the intervertebral disc, vertebral body, and paravertebral soft tissues. Damaged intervertebral structure is a major cause of persistent back pain even after successful antibiotic therapy, which can be improved by achieving autofusion or via additional surgical fixation. In this study, we analyzed the clinical and radiological features predicting intervertebral autofusion after successful antibiotic therapy in lumbar PVO.
Methods:
This study was retrospectively conducted with 32 patients (20 men and 12 women) diagnosed with lumbar PVO that was completely cured with no recurrences after antibiotic therapy. They were divided into two groups with (group A, n = 18) and without (group B, n = 14) intervertebral autofusion at six-month follow-up. Differences in back pain, blood inflammatory markers, and radiological features of PVO on simultaneous 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG-PET/MRI) of the intervertebral structure between the two groups were analyzed.
Results:
The mean duration of antibiotic therapy was 41.44 ± 14.21 (21-89) days. Group A showed a statistically higher erythrocyte sedimentation ratio (ESR; 59.28 ± 32.33 vs. 33.93 ± 18.76 mm/h, p = 0.014; normal range of ESR < 25), maximum standardized 18F-FDG uptake (SUVmax; 5.56 ± 1.86 vs. 3.98 ± 1.40, p = 0.013), and sustained extensive edematous changes on T2-weighted fat saturation (T2FS) MRI (p = 0.015) immediately after successful antibiotic therapy. However, no significant differences were observed in back pain, C-reactive protein, or the distribution of 18F-FDG uptake/contrast enhancement on 18F-FDG-PET/MRI (p > 0.05).
Conclusions:
Higher ESR and SUVmax of the intervertebral structure and sustained extensive edematous change on T2FS MRI immediately after successful antibiotic therapy are related with subsequent intervertebral autofusion, which should be carefully considered when assessing therapeutic response in PVO.
Insights
Higher erythrocyte sedimentation ratio (ESR) and 18F-FDG PET/MRI uptake (SUVmax) predict intervertebral autofusion in lumbar pyogenic vertebral osteomyelitis (PVO). These findings aid in assessing treatment response after antibiotics.
Area of Science:
- Orthopedics
- Infectious Diseases
- Radiology
Background:
- Pyogenic vertebral osteomyelitis (PVO) is a bacterial infection of the spine.
- Persistent back pain can occur despite antibiotic treatment due to intervertebral structural damage.
- Intervertebral autofusion is a potential outcome that can alleviate pain.
Purpose of the Study:
- To identify clinical and radiological predictors of intervertebral autofusion.
- To analyze features associated with successful autofusion after antibiotic therapy in lumbar PVO.
- To improve the assessment of therapeutic response in PVO patients.
Main Methods:
- Retrospective study of 32 patients with cured lumbar PVO.
- Patients divided into groups with (n=18) and without (n=14) autofusion at 6-month follow-up.
- Analysis of back pain, inflammatory markers (ESR, CRP), and 18F-FDG-PET/MRI findings.
Main Results:
- Higher erythrocyte sedimentation ratio (ESR) in the autofusion group (59.28 vs. 33.93 mm/h).
- Increased maximum standardized 18F-FDG uptake (SUVmax) in the autofusion group (5.56 vs. 3.98).
- Sustained extensive edematous changes on T2FS MRI were more common in the autofusion group.
Conclusions:
- Elevated ESR, SUVmax, and persistent T2FS MRI edema predict intervertebral autofusion post-antibiotic therapy for PVO.
- These markers are crucial for evaluating treatment outcomes in lumbar PVO.
- Consideration of these factors aids in managing persistent back pain.
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