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Discitis-osteomyelitis: optimizing results of percutaneous sampling.

Jad S Husseini1, Ambrose J Huang2

  • 1Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA. jad.husseini@mgh.harvard.edu.

Skeletal Radiology
|August 17, 2022
PubMed
Summary
This summary is machine-generated.

Percutaneous sampling aids in diagnosing vertebral discitis-osteomyelitis when cultures are negative. Optimizing sampling techniques and timing can improve diagnostic yield for targeted treatment.

Keywords:
AspirationBiopsyDiscitisMicrobiologyOsteomyelitisSpine

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Area of Science:

  • Infectious Diseases
  • Orthopedic Surgery
  • Radiology

Background:

  • Vertebral discitis-osteomyelitis is a spinal infection affecting intervertebral discs and vertebral bodies, potentially spreading to soft tissues.
  • Microbial identification is crucial for targeted antimicrobial therapy when initial blood cultures are unrevealing.

Purpose of the Study:

  • To outline the indications and optimal techniques for percutaneous sampling in diagnosing vertebral discitis-osteomyelitis.
  • To review strategies for maximizing microbiological yield from percutaneous biopsies.

Main Methods:

  • Percutaneous sampling via image guidance (e.g., CT or ultrasound) to target affected spinal areas.
  • Collection of multiple core samples using larger gauge needles when feasible.
  • Consideration of withholding antibiotics for up to two weeks prior to sampling to enhance microbial detection.

Main Results:

  • Percutaneous sampling is indicated when blood cultures fail to identify the causative pathogen.
  • Targeting paraspinal fluid collections or soft tissue abnormalities may improve diagnostic yield.
  • Repeat sampling, if necessary, should be performed at least 72 hours after the initial biopsy.

Conclusions:

  • Percutaneous sampling is a valuable tool for diagnosing vertebral discitis-osteomyelitis when conventional methods fail.
  • Specific technical considerations and procedural timing can significantly enhance the success rate of microbiological diagnosis.