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Computed Tomography–Guided Spinal Biopsy in Suspected Infective Spondylodiscitis: An Institutional Review of Its UtilityFunding None.
Background Infectious spondylodiscitis is a debilitating condition and evidence-based medicine dictates confirming the diagnosis before treatment. Computed tomography–guided spinal biopsy plays a major role and hence we would like to determine its utility in current clinical practice.
Purpose The purpose of this study is to determine the percentage of confirmatory positives of CT-guided spinal biopsy in patients who were clinicoradiologically diagnosed with infectious spondylitis.
Material and Methods A retrospective analysis of patients who underwent CT-guided biopsy for suspected infectious spondylodiscitis from 2017 to 2021 in a tertiary medical center was done. The data were filtered and obtained from the electronic database of the institution.
Results In all, 259 patients underwent CT-guided biopsy of the spine. The procedure provided confirmatory results in 149 (57.5%) biospecimens. Histopathology examination was confirmatory in 95 (36.6%) of the 241 biospecimens sent. The Mycobacteria Growth Indicator Tube (MGIT) was confirmatory in 51 (19.9%) of the 250 biospecimens sent and drug resistance was seen in 6/51 (11.7%) biospecimens. Xpert TB provided confirmatory results in 72 (27.8%) of the 254 biospecimens sent and rifampicin resistance was seen in 16/72 (22.2%) biospecimens. Bacterial culture was confirmatory in 29 (11.2%) of the 250 biospecimens sent. The complication documented in this study was 0.3%.
Conclusion CT-guided spinal biopsy for suspected vertebral osteomyelitis is a safe and effective minimally invasive procedure. It demonstrates a positive yield in more than half of the patients. Knowing the outcome, the patients can be appropriately counseled prior to the procedure. CT-guided biopsy results were affected by prior administration of ATT (antitubercular therapy) in suspected tuberculous spondylitis patients.
Keywordsspine biopsy - CT - infectious spondylodiscitis - tuberculous spondylodiscitis - pyogenic spondylodiscitis - antitubercular therapy
Article published online:
06 May 2023
© 2023. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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- 1 Cottle L, Riordan T. Infectious spondylodiscitis. J Infect 2008; 56 (06) 401-412
- 2 Lam KS, Webb JK. Discitis. Hosp Med 2004; 65 (05) 280-286
- 3 Ross PM, Fleming JL. Vertebral body osteomyelitis: spectrum and natural history. A retrospective analysis of 37 cases. Clin Orthop Relat Res 1976; (118) 190-198
- 4 Waheed G, Soliman MAR, Ali AM, Aly MH. Spontaneous spondylodiscitis: review, incidence, management, and clinical outcome in 44 patients. Neurosurg Focus 2019; 46 (01) E10
- 5 Martín-Alonso J, Delgado-López PD, Castilla-Díez JM. et al. Role of surgery in spontaneous spondylodiscitis: experience in 83 consecutive patients. Neurocirugia (Astur : Engl Ed) 2018; 29: 64-78
- 6 Kang M, Gupta S, Khandelwal N, Shankar S, Gulati M, Suri S. CT-guided fine-needle aspiration biopsy of spinal lesions. Acta Radiol 1999; 40 (05) 474-478
- 7 Feroz I, Makhdoomi RH, Khursheed N, Shaheen F, Shah P. Utility of computed tomography-guided biopsy in evaluation of metastatic spinal lesions. Asian J Neurosurg 2018; 13 (03) 577-584
- 8 Joo E-J, Yeom J-S, Ha YE. et al. Diagnostic yield of computed tomography-guided bone biopsy and clinical outcomes of tuberculous and pyogenic spondylitis. Korean J Intern Med (Korean Assoc Intern Med) 2016; 31 (04) 762-771
- 9 Chew FS, Kline MJ. Diagnostic yield of CT-guided percutaneous aspiration procedures in suspected spontaneous infectious discitis. Radiology 2001; 218 (01) 211-214
- 10 Garg V, Kosmas C, Young PC, Togaru UK, Robbin MR. Computed tomography-guided percutaneous biopsy for vertebral osteomyelitis: a department's experience. Neurosurg Focus 2014; 37 (02) E10
- 11 Waqas M, Qadeer M, Faiz F, Alvi MA, Bari ME. Computed tomography-guided biopsy for potts disease: an institutional experience from an endemic developing country. Asian Spine J 2015; 9 (03) 394-398
- 12 Rehm J, Veith S, Akbar M, Kauczor HU, Weber MA. CT-guided percutaneous spine biopsy in suspected infection or malignancy: a study of 214 patients. Röfo Fortschr Geb Röntgenstr Neuen Bildgeb Verfahr 2016; 188 (12) 1156-1162
- 13 Enoch DA, Cargill JS, Laing R, Herbert S, Corrah TW, Brown NM. Value of CT-guided biopsy in the diagnosis of septic discitis. J Clin Pathol 2008; 61 (06) 750-753
- 14 Nam KH, Song GS, Han IH, Choi BK, Cha SH. Diagnostic value of biopsy techniques in lumbar spondylodiscitis: percutaneous needle biopsy and open biopsy. Korean J Spine 2011; 8 (04) 267-271
- 15 Babu NV, Titus VT, Chittaranjan S, Abraham G, Prem H, Korula RJ. Computed tomographically guided biopsy of the spine. Spine 1994; 19 (21) 2436-2442
- 16 Rankine JJ, Barron DA, Robinson P, Millner PA, Dickson RA. Therapeutic impact of percutaneous spinal biopsy in spinal infection. Postgrad Med J 2004; 80 (948) 607-609
- 17 Hassoun A, Taur Y, Singer C. Evaluation of thin needle aspiration biopsy in the diagnosis and management of vertebral osteomyelitis (VO). Int J Infect Dis 2006; 10 (06) 486-487
- 18 Peh W. CT-guided percutaneous biopsy of spinal lesions. Biomed Imaging Interv J 2006; 2 (03) e25