Tag: Spondylodiscitis

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Comparing the diagnostic accuracies of F-18 FDG PET and MRI for the detection of spondylodiscitis: A meta-analysis

Spine. 44(7):E414-E422, April 1, 2019

The aim of this study was to compare the diagnostic accuracies of F-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography (PET) and magnetic resonance imaging (MRI) for the detection of spondylodiscitis through a meta-analysis.

Summary of Background Data. There is no meta-analysis study that compares the diagnostic accuracies of F-18 FDG PET and MRI for the detection of spondylodiscitis.

Methods. The MEDLINE and EMBASE databases were searched from the earliest available date of indexing to January 10, 2018 for studies comparing the diagnostic performance F-18 FDG PET with that of MRI for the detection of spondylodiscitis. We determined the sensitivities and specificities across studies, calculated the positive and negative likelihood ratios (LR+ and LR-), and constructed the summary receiver operating characteristic curves.

Results. In the seven studies (212 patients) selected, the pooled sensitivity and specificity of F- 18 FDG PET were 0.95 (95% confidence interval [CI]: 0.87-0.98) and 0.88 (95% CI: 0.73-0.95), respectively. The LR syntheses showed an overall LR+ of 7.6 (95% CI: 3.4-17.2) and LR- of 0.05 (95% CI: 0.02-0.14). The pooled diagnostic odds ratio (DOR) was 141 (95% CI: 44-444). The pooled sensitivity and specificity of MRI were 0.85 (95% CI: 0.65-0.95) and 0.66 (95% CI: 0.48-0.80), respectively. The LR syntheses showed an overall LR+ of 2.5 (95% CI: 1.5-4.2) and LR- of 0.22 (95% CI: 0.08-0.60). The pooled DOR was 11 (95% CI: 3-42). In the metaregression analysis, no variable was identified as the source of the study heterogeneity.

Conclusions. The current meta-analysis shows that F-18 FDG PET has better diagnostic accuracy than MRI for the detection of spondylodiscitis. Further large multicenter studies would be necessary to substantiate the diagnostic accuracies of F-18 FDG PET and MRI for spondylodiscitis.

Level of Evidence: 2

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Management of spinal infection: a review of the literature

Acta Neurochirurgica (2018) 160:487–496

Spinal infection (SI) is defined as an infectious disease affecting the vertebral body, the intervertebral disc, and/or adjacent paraspinal tissue and represents 2–7% of all musculoskeletal infections. There are numerous factors, which may facilitate the development of SI including not only advanced patient age and comorbidities but also spinal surgery. Due to the low specificity of signs, the delay in diagnosis of SI remains an important issue and poor outcome is frequently seen. Diagnosis should always be supported by clinical, laboratory, and imaging findings, magnetic resonance imaging (MRI) remaining the most reliable method. Management of SI depends on the location of the infection (i.e., intraspinal, intervertebral, paraspinal), on the disease progression, and of course on the patient’s general condition, considering age and comorbidities. Conservative treatment mostly is reasonable in early stages with no or minor neurologic deficits and in case of severe comorbidities, which limit surgical options. Nevertheless, solely medical treatment often fails. Therefore, in case of doubt, surgical treatment should be considered. The final result in conservative as well as in surgical treatment always is bony fusion. Furthermore, both options require a concomitant antimicrobial therapy, initially applied intravenously and administered orally thereafter. The optimal duration of antibiotic therapy remains controversial, but should never undercut 6 weeks. Due to a heterogeneous and often comorbid patient population and the wide variety of treatment options, no generally applicable guidelines for SI exist and management remains a challenge. Thus, future prospective randomized trials are necessary to substantiate treatment strategies.

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Outcome of conservative and surgical treatment of pyogenic spondylodiscitis

pyogenic spondylodiscitis

Eur Spine J (2016) 25:983–999

Spondylodiscitis is a spinal infection affecting primarily the intervertebral disk and the adjacent vertebral bodies. Currently many aspects of the treatment of pyogenic spondylodiscitis are still a matter of debate.

Purpose The aim of this study was to review the currently available literature systematically to determine the outcome of patients with pyogenic spondylodiscitis for conservative and surgical treatment strategies.

Methods A systematic electronic search of MEDLINE, EMBASE, Cochrane Collaboration, and Web of Science regarding the treatment of pyogenic spondylodiscitis was performed. Included articles were assessed on risk of bias according the Cochrane Handbook for Systematic Reviews of Interventions, and the quality of evidence and strength of recommendation was evaluated according the GRADE approach.

Results: 25 studies were included. Five studies had a high or moderate quality of evidence. One RCT suggest that 6 weeks of antibiotic treatment of pyogenic spondylodiscitis results in a similar outcome when compared to longer treatment duration. However, microorganism-specific studies suggest that at least 8 weeks of treatment is required for S. aureus and 8 weeks of Daptomycin for MRSA. The articles that described the outcome of surgical treatment strategies show that a large variety of surgical techniques can successfully treat spondylodiscitis. No additional long-term beneficial effect of surgical treatment could be shown in the studies comparing surgical versus antibiotic only treatment.

Conclusion There is a strong level of recommendation for 6 weeks of antibiotic treatment in pyogenic spondylodiscitis although this has only been shown by one recent RCT. If surgical treatment is indicated, it has been suggested by two prospective studies with strong level of recommendation that an isolated anterior approach could result in a better clinical outcome.

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