Is There a Role for Repeated Biopsy in Cases of Negative Disk Biopsy for Suspected Infectious Spondylodiskitis?

Purpose or Learning Objective: This retrospective observational study evaluated the diagnostic efficacy of image-guided disk-vertebral biopsies in patients with suspected infectious spondylodiskitis. In particular, it assessed the usefulness of a second biopsy following an initial negative result and analyzed the factors associated with a positive microbiological result.

Methods or Background: The study included adult patients who underwent image-guided (computed tomography and fluoroscopy) disk-vertebral biopsies for suspected infectious spondylodiskitis based on clinical, laboratory, and imaging findings. Exclusion criteria were biopsies performed for noninfectious conditions (e.g., metastases or primary bone tumors) or cases where biopsy results and clinical/radiologic data indicated noninfectious pathology.

Results or Findings: A total of 93 biopsies in 79 patients were analyzed—79 first biopsies, 13 second biopsies, and 1 third biopsy—performed at a single center from January 2019 to June 2024. The overall microbiological positivity rate was 59.5% (n = 47/79), with the first biopsy achieving a positivity rate of 53.1% (n = 42/79) and rebiopsies yielding 35.7% (n = 5/14). In our cohort, the most frequently identified pathogens were Staphylococcus epidermidis, followed by Cutibacterium acnes, Staphylococcus aureus, Pseudomonas aeruginosa, multibacterial infections, and fungi. The microbiological sensitivity of the second biopsy did not significantly differ from that of the first (P = 0.36), demonstrating its comparable effectiveness in identifying causative pathogens. Elevated C-reactive protein levels were significantly associated with a positive biopsy result (mean C-reactive protein: 54.5 mg/L in positive cases versus 29.4 mg/L in negative cases; P = 0.0082), whereas no significant correlation was found with age, sex, or leukocyte count. Blood cultures were often negative, with positivity observed in only 7.8% (7/90) of cases. In 6 of these 7 cases, the pathogen identified in the blood culture matched the biopsy findings, showing high specificity of blood cultures when positive. In postsurgical infections, the diagnostic yield was higher, with bacterial identification achieved in 80% of cases (4/5).

Conclusion: These findings support the use of rebiopsy to improve the overall diagnostic accuracy in cases with persistent clinical suspicion of infection after an initial negative result, especially as a less invasive alternative to surgical biopsy.

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Artikel online veröffentlicht:
02. Juni 2025