Articles | Volume 7, issue 1
https://doi.org/10.5194/jbji-7-23-2022
© Author(s) 2022. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-7-23-2022
© Author(s) 2022. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Review
| 
27 Jan 2022
Review |
| 27 Jan 2022
| 27 Jan 2022
Diagnosis of vertebral osteomyelitis
Julian Maamari
Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
Aaron J. Tande
Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
Felix Diehn
Department of Radiology, Mayo Clinic, Rochester, MN, USA
Don Bambino Geno Tai
Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
Elie F. Berbari
CORRESPONDING AUTHOR
Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
Related authors
Matteo Passerini, Julian Maamari, Don Bambino Geno Tai, Robin Patel, Aaron J. Tande, Zelalem Temesgen, and Elie F. Berbari
J. Bone Joint Infect., 8, 143–149, https://doi.org/10.5194/jbji-8-143-2023, https://doi.org/10.5194/jbji-8-143-2023, 2023
Short summary
Short summary
Physicians have difficulties interpreting the isolation of Cutibacterium acnes in the spine tissue. Here we provide the experience of our center about this topic, adding data that can help physicians in their choices. Our results show that some clinical, radiological, and microbiological features can help distinguish patients to treat or not to treat. Moreover, treatment with parenteral beta-lactams appears to be effective, but targeted oral therapy could be a valid alternative.
Matteo Passerini, Julian Maamari, Tarek Nayfeh, Leslie C. Hassett, Aaron J. Tande, Mohammad H. Murad, Zelalem Temesgen, and Elie F. Berbari
J. Bone Joint Infect., 7, 249–257, https://doi.org/10.5194/jbji-7-249-2022, https://doi.org/10.5194/jbji-7-249-2022, 2022
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Despite a growing interest in oral therapy for native vertebral osteomyelitis, there is no evidence to recommend oral or parenteral therapy. From our single-center experience combined with a systematic review and a meta-analysis of the available literature, there is insufficient evidence to conclude that there is a difference in proportion of failure and relapse between an early switch to oral antibiotics and prolonged parenteral therapy. Further studies are needed to increase the evidence.
Francesco Petri, Omar Mahmoud, Said El Zein, Ahmad Nassr, Brett A. Freedman, Jared T. Verdoorn, Aaron J. Tande, and Elie F. Berbari
J. Bone Joint Infect., 9, 173–182, https://doi.org/10.5194/jbji-9-173-2024, https://doi.org/10.5194/jbji-9-173-2024, 2024
Short summary
Short summary
In recent years, there has been an increase in scientific production on native vertebral osteomyelitis (NVO), a condition whose incidence is rising and that can be highly detrimental to health. However, there is no consensus on the definition of this syndrome in the medical community. Therefore, we propose a new framework to synthesize the diagnostic tools at our disposal. This can help to advance research further and guide patient care more effectively.
Nicolás Cortés-Penfield, Don Bambino Geno Tai, and Angela Hewlett
J. Bone Joint Infect., 9, 161–165, https://doi.org/10.5194/jbji-9-161-2024, https://doi.org/10.5194/jbji-9-161-2024, 2024
Short summary
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This survey study describes the composition of US-based orthopedic infectious diseases (Ortho ID) teams across more than a dozen large academic medical centers, finding many institutions have dedicated Ortho ID clinics or inpatient services. These teams are highly valued by both ID clinicians and surgeons for engendering strong multidisciplinary relationships and improving patient outcomes.
Said El Zein, Elie F. Berbari, Allison M. LeMahieu, Anil Jagtiani, Parham Sendi, Abinash Virk, Mark E. Morrey, and Aaron J. Tande
J. Bone Joint Infect., 9, 107–115, https://doi.org/10.5194/jbji-9-107-2024, https://doi.org/10.5194/jbji-9-107-2024, 2024
Short summary
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Our study investigated olecranon septic bursitis treatment, focusing on postsurgical antibiotic use. Analyzing 22 years of Mayo Clinic data, we found that smoking and not administering antibiotics following surgery led to poorer outcomes. A 3-week antibiotic course following surgery was most effective. Our findings suggest that a subset of patients may benefit from longer courses of antibiotics; however, further research is needed to confirm these findings.
Pansachee Damronglerd, Eibhlin Higgins, Madiha Fida, Don Bambino Geno Tai, Aaron J. Tande, Matthew P. Abdel, and Omar M. Abu Saleh
J. Bone Joint Infect., 9, 99–106, https://doi.org/10.5194/jbji-9-99-2024, https://doi.org/10.5194/jbji-9-99-2024, 2024
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This work investigates periprosthetic joint infection (PJI) caused by rapidly growing mycobacteria (RGM) following total joint arthroplasty. Eight patients were identified as part of a retrospective review. The isolated RGM species included Mycobacterium abscessus (three cases), M. fortuitum (three cases), and one case each of M. immunogenum and M. mageritense. We provide novel insights into the successful treatment of PJIs caused by newly identified RGM (M. immunogenum and M. mageritense).
Matteo Passerini, Julian Maamari, Don Bambino Geno Tai, Robin Patel, Aaron J. Tande, Zelalem Temesgen, and Elie F. Berbari
J. Bone Joint Infect., 8, 143–149, https://doi.org/10.5194/jbji-8-143-2023, https://doi.org/10.5194/jbji-8-143-2023, 2023
Short summary
Short summary
Physicians have difficulties interpreting the isolation of Cutibacterium acnes in the spine tissue. Here we provide the experience of our center about this topic, adding data that can help physicians in their choices. Our results show that some clinical, radiological, and microbiological features can help distinguish patients to treat or not to treat. Moreover, treatment with parenteral beta-lactams appears to be effective, but targeted oral therapy could be a valid alternative.
Eibhlin Higgins, Don Bambino Geno Tai, Brian Lahr, Gina A. Suh, Elie F. Berbari, Kevin I. Perry, Matthew P. Abdel, and Aaron J. Tande
J. Bone Joint Infect., 8, 125–131, https://doi.org/10.5194/jbji-8-125-2023, https://doi.org/10.5194/jbji-8-125-2023, 2023
Short summary
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This retrospective case-matched study evaluated males and females with staphylococcal PJI (periprosthetic joint infection) treated with two-stage exchange arthroplasty. We matched 156 males and females for age, type of staphylococcal infection, and joint involved. We compared clinical parameters related to presentation, treatment, and outcome. We did not find a statistically significant difference in outcome between males and females treated with the same surgical approach at our institution.
Kareme D. Alder, Anthony P. Fiegen, Matthew M. Rode, Don Bambino Geno Tai, Gina A. Suh, Abinash Virk, and Nicholas Pulos
J. Bone Joint Infect., 8, 39–44, https://doi.org/10.5194/jbji-8-39-2023, https://doi.org/10.5194/jbji-8-39-2023, 2023
Short summary
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We present the first published case of bilateral extensor tenosynovitis caused by Coxiella burnetii. C. burnetii should be considered in patients with inflammatory osteoarticular disease, including tenosynovitis, when conventional cultures are negative especially in elderly, male, or immunocompromised patients with exposure to animals.
Matteo Passerini, Julian Maamari, Tarek Nayfeh, Leslie C. Hassett, Aaron J. Tande, Mohammad H. Murad, Zelalem Temesgen, and Elie F. Berbari
J. Bone Joint Infect., 7, 249–257, https://doi.org/10.5194/jbji-7-249-2022, https://doi.org/10.5194/jbji-7-249-2022, 2022
Short summary
Short summary
Despite a growing interest in oral therapy for native vertebral osteomyelitis, there is no evidence to recommend oral or parenteral therapy. From our single-center experience combined with a systematic review and a meta-analysis of the available literature, there is insufficient evidence to conclude that there is a difference in proportion of failure and relapse between an early switch to oral antibiotics and prolonged parenteral therapy. Further studies are needed to increase the evidence.
Talha Riaz, Matthew Howard, Felix Diehn, Aaron Joseph Tande, Courtney Ross, Paul Huddleston, and Elie Berbari
J. Bone Joint Infect., 7, 213–219, https://doi.org/10.5194/jbji-7-213-2022, https://doi.org/10.5194/jbji-7-213-2022, 2022
Short summary
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In this study, we prospectively enrolled patients with a suspected diagnosis of native vertebral osteomyelitis (NVO) undergoing image-guided needle aspiration of the intervertebral disc. Based on this pilot study, a high manual cell count or a high neutrophilic predominance from the disc aspirate was associated with the diagnosis of NVO.
Katharine Dobos, Gina A. Suh, Aaron J. Tande, and Shanthi Kappagoda
J. Bone Joint Infect., 7, 137–141, https://doi.org/10.5194/jbji-7-137-2022, https://doi.org/10.5194/jbji-7-137-2022, 2022
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This paper describes five cases of prosthetic joint infection (PJI) caused by Mycobacterium avium complex (MAC). Infections occurred in both immune competent and immunosuppressed patients. Interestingly, using the Musculoskeletal Infection Society diagnostic criteria for PJI may miss some cases of MAC PJI. Treatment courses and outcomes are described.
Miao Xian Zhou, Elie F. Berbari, Cory G. Couch, Scott F. Gruwell, and Alan B. Carr
J. Bone Joint Infect., 6, 363–366, https://doi.org/10.5194/jbji-6-363-2021, https://doi.org/10.5194/jbji-6-363-2021, 2021
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This was written to outline Mayo Clinic guidelines on prophylactic antibiotics prior to invasive procedures in patients with prosthetic joints. There is an emphasis on maintaining optimal oral health to reduce the risk of infection to minimize the patient’s risk of PJI.
Don Bambino Geno Tai, Nathan J. Brinkman, Omar Abu Saleh, Douglas R. Osmon, Matthew P. Abdel, and Christina G. Rivera
J. Bone Joint Infect., 6, 147–150, https://doi.org/10.5194/jbji-6-147-2021, https://doi.org/10.5194/jbji-6-147-2021, 2021
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Antibiotics are frequently used in bone cement during joint replacements or treatment of bone and joint infections. Amikacin is rarely used in bone cement, particularly the liquid formulation. We describe a series of patients in which liquid amikacin was incorporated into bone cement. We did not observe the occurrence of adverse drug reactions definitively attributed to its use. All patients had favorable outcomes.
Stephanie L. Grach and Aaron J. Tande
J. Bone Joint Infect., 6, 39–42, https://doi.org/10.5194/jbji-6-39-2020, https://doi.org/10.5194/jbji-6-39-2020, 2020
Related subject area
Subject: Osteomyelitis | Topic: Diagnosis
Ureaplasma urealyticum osteomyelitis of the greater trochanter in a patient with multiple sclerosis using ocrelizumab – a case report
Outcomes in patients with clinically suspected pedal osteomyelitis based on bone marrow signal pattern on MRI
Osteomyelitis in heterotopic ossification in a patient with congenital gigantism of the leg
Diagnosing pelvic osteomyelitis in patients with pressure ulcers: a systematic review comparing bone histology with alternative diagnostic modalities
Fred Ruythooren, Stijn Ghijselings, Melissa Depypere, Willem-Jan Metsemakers, Liesbet Henckaerts, Nathalie Noppe, and Georges Vles
J. Bone Joint Infect., 9, 167–171, https://doi.org/10.5194/jbji-9-167-2024, https://doi.org/10.5194/jbji-9-167-2024, 2024
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The article examines a unique case of Ureaplasma urealyticum causing osteomyelitis in the greater trochanter of a 26-year-old male treated with ocrelizumab for multiple sclerosis. It emphasizes the necessity of a multidisciplinary approach and advanced PCR diagnostics to manage such rare opportunistic infections effectively, highlighting the challenges faced due to the immunosuppressive nature of monoclonal antibody therapies of this kind.
Christin A. Tiegs-Heiden, Tanner C. Anderson, Mark S. Collins, Matthew P. Johnson, Douglas R. Osmon, and Doris E. Wenger
J. Bone Joint Infect., 8, 99–107, https://doi.org/10.5194/jbji-8-99-2023, https://doi.org/10.5194/jbji-8-99-2023, 2023
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Magnetic resonance imaging (MRI) is an imaging test that is often used in patients with a suspected bone infection in their foot. MRI findings may impact how these patients are treated; thus, it is important to understand the significance of various MRI findings. This study compared different patterns of MRI findings in these patients to their clinical outcomes. Patients with classic features of bone infection on MRI had the worst outcomes, whereas patients without them sometimes healed.
Martina Galea Wismayer, Kurstein Sant, Ryan Giordmaina, and Martin McNally
J. Bone Joint Infect., 6, 141–145, https://doi.org/10.5194/jbji-6-141-2021, https://doi.org/10.5194/jbji-6-141-2021, 2021
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We report the treatment of bone infection in a patient with a rare disease which causes overgrowth of the limb. Careful assessment of the scans showed that the infection was in some new bone which had formed in the soft tissues after a minor injury to the leg and not in one of the major bones. This made treatment much easier with a successful outcome.
Maria Chicco, Prashant Singh, Younatan Beitverda, Gillian Williams, Hassan Hirji, and Guduru Gopal Rao
J. Bone Joint Infect., 6, 21–32, https://doi.org/10.5194/jbji-6-21-2020, https://doi.org/10.5194/jbji-6-21-2020, 2020
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Accurate diagnosis of bone infections underlying bed sores is essential. Microscopic examination of bone samples is the preferred method for diagnosis, but alternative modalities are commonly used in everyday practice. We conducted a systematic review comparing results of microscopic examination with those of alternative modalities. Our study did not find any other method to be a reliable alternative for the diagnosis of bone infections underlying bed sores compared to microscopic examination.
Cited articles
Ahn, K.-S., Kang, C. H., Hong, S.-J., Kim, B. H., and Shim, E.: The
correlation between follow-up MRI findings and laboratory results in
pyogenic spondylodiscitis, BMC Musculoskel. Di., 21, 428,
https://doi.org/10.1186/s12891-020-03446-4, 2020.
An, H. S. and Seldomridge, J. A.: Spinal Infections: Diagnostic Tests and
Imaging Studies, Clin. Orthop., 444, 27–33,
https://doi.org/10.1097/01.blo.0000203452.36522.97, 2006.
Bateman, J. L. and Pevzner, M. M.: SPINAL OSTEOMYELITIS: A REVIEW OF 10 YEARS’ EXPERIENCE, Orthopedics, 18, 561–565, https://doi.org/10.3928/0147-7447-19950601-10, 1995.
Behmanesh, B., Gessler, F., Schnoes, K., Dubinski, D., Won, S.-Y.,
Konczalla, J., Seifert, V., Weise, L., and Setzer, M.: Infective
endocarditis in patients with pyogenic spondylodiscitis: implications for
diagnosis and therapy, Neurosurg. Focus, 46, E2,
https://doi.org/10.3171/2018.10.FOCUS18445, 2019.
Berbari, E. F., Kanj, S. S., Kowalski, T. J., Darouiche, R. O., Widmer, A.
F., Schmitt, S. K., Hendershot, E. F., Holtom, P. D., Huddleston, P. M.,
Petermann, G. W., and Osmon, D. R.: 2015 Infectious Diseases Society of
America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment
of Native Vertebral Osteomyelitis in Adultsa, Clin. Infect. Dis., 61,
e26–e46, https://doi.org/10.1093/cid/civ482, 2015.
Bruschwein, D. A., Brown, M. L., and McLeod, R. A.: Gallium Scintigraphy in the Evaluation of Disk-Space Infections: Concise Communication, J. Nucl. Med., 21, 925–927, 1980.
Carragee, E. J., Kim, D., van der Vlugt, T., and Vittum, D.: The Clinical
Use of Erythrocyte Sedimentation Rate in Pyogenic Vertebral Osteomyelitis,
Spine, 22, 2089–2093, 1997.
Carrino, J. A., Khurana, B., Ready, J. E., Silverman, S. G., and Winalski,
C. S.: Magnetic Resonance Imaging-Guided Percutaneous Biopsy of
Musculoskeletal Lesions, J. Bone Joint. Surg., 89, 2179–2187,
https://doi.org/10.2106/JBJS.F.01230, 2007.
Chelsom, J. and Solberg, C. O.: Vertebral Osteomyelitis at a Norwegian University Hospital 1987–97: Clinical Features, Laboratory Findings and Outcome, Scand. J. Infect. Dis., 30, 147–151, https://doi.org/10.1080/003655498750003537, 1998.
Chenoweth, C. E., Bassin, B. S., Mack, M. R., Oppenlander, M. E., Patel, R.
D., Quint, D. J., and Seagull, F. J.: Vertebral Osteomyelitis, Discitis, and
Spinal Epidural Abscess in Adults, Quality Department guidelines report,
Michigan Medicine University of Michigan,
Ann Arbor (MI), available at: https://www-ncbi-nlm-nih-gov.mclibrary.idm.oclc.org/books/NBK547443/pdf/Bookshelf_NBK547443.pdf (last access: 17 January 2022), 2018.
Chew, F. S. and Kline, M. J.: Diagnostic Yield of CT-guided Percutaneous
Aspiration Procedures in Suspected Spontaneous Infectious Diskitis,
Radiology, 218, 211–214,
https://doi.org/10.1148/radiology.218.1.r01ja06211, 2001.
Chiang, H.-Y., Chung, C.-W., Kuo, C.-C., Lo, Y.-C., Chang, W.-S., and Chi,
C.-Y.: First-4-week erythrocyte sedimentation rate variability predicts
erythrocyte sedimentation rate trajectories and clinical course among
patients with pyogenic vertebral osteomyelitis, Plos One, 14, e0225969,
https://doi.org/10.1371/journal.pone.0225969, 2019.
Choe, H., Aota, Y., Kobayashi, N., Nakamura, Y., Wakayama, Y., Inaba, Y.,
and Saito, T.: Rapid sensitive molecular diagnosis of pyogenic spinal
infections using methicillin-resistant Staphylococcus-specific polymerase
chain reaction and 16S ribosomal RNA gene-based universal polymerase chain
reaction, Spine J., 14, 255–262,
https://doi.org/10.1016/j.spinee.2013.10.044, 2014.
Colmenero, J. D., Ruiz-Mesa, J. D., Sanjuan-Jimenez, R., Sobrino, B., and
Morata, P.: Establishing the diagnosis of tuberculous vertebral
osteomyelitis, Eur. Spine J., 22, 579–586,
https://doi.org/10.1007/s00586-012-2348-2, 2013.
Dagirmanjian, A., Schils, J., McHenry, M., and Modic, M. T.: MR imaging of vertebral osteomyelitis revisited., Am. J. Roentgenol., 167, 1539–1543, https://doi.org/10.2214/ajr.167.6.8956593, 1996.
De Pauw, B., Walsh, T. J., Donnelly, J. P., Stevens, D. A., Edwards, J. E.,
Calandra, T., Pappas, P. G., Maertens, J., Lortholary, O., Kauffman, C. A.,
Denning, D. W., Patterson, T. F., Maschmeyer, G., Bille, J., Dismukes, W.
E., Herbrecht, R., Hope, W. W., Kibbler, C. C., Kullberg, B. J., Marr, K.
A., Muñoz, P., Odds, F. C., Perfect, J. R., Restrepo, A., Ruhnke, M.,
Segal, B. H., Sobel, J. D., Sorrell, T. C., Viscoli, C., Wingard, J. R.,
Zaoutis, T., and Bennett, J. E.: Revised Definitions of Invasive Fungal
Disease from the European Organization for Research and Treatment of
Cancer/Invasive Fungal Infections Cooperative Group and the National
Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG)
Consensus Group, Clin. Infect. Dis., 46, 1813–1821,
https://doi.org/10.1086/588660, 2008.
Diehn, F. E.: Imaging of Spine Infection, Radiol. Clin. N. Am., 50,
777–798, https://doi.org/10.1016/j.rcl.2012.04.001, 2012.
Fernandez, M., Carrol, C. L., and Baker, C. J.: Discitis and Vertebral Osteomyelitis in Children: An 18-Year Review, Pediatrics, 105, 1299–1304, https://doi.org/10.1542/peds.105.6.1299, 2000.
Fuster, D., Solà, O., Soriano, A., Monegal, A., Setoain, X., Tomás,
X., Garcia, S., Mensa, J., Rubello, D., and Pons, F.: A Prospective Study
Comparing Whole-Body FDG PET/CT to Combined Planar Bone Scan With 67Ga
SPECT/CT in the Diagnosis of Spondylodiskitis, Clin. Nucl. Med., 37,
827–832, https://doi.org/10.1097/RLU.0b013e318262ae6c, 2012.
Govender, S.: Spinal infections, J. Bone Joint Surg. Br., 87-B, 1454–1458,
https://doi.org/10.1302/0301-620X.87B11.16294, 2005.
Gras, G., Buzele, R., Parienti, J. J., Debiais, F., Dinh, A., Dupon, M.,
Roblot, F., Mulleman, D., Marcelli, C., Michon, J., and Bernard, L.:
Microbiological diagnosis of vertebral osteomyelitis: relevance of second
percutaneous biopsy following initial negative biopsy and limited yield of
post-biopsy blood cultures, Eur. J. Clin. Microbiol. Infect. Dis., 33,
371–375, https://doi.org/10.1007/s10096-013-1965-y, 2014.
Gratz, S., Dörner, J., Oestmann, J. W., Opitz, M., Behr, T., Meller, J., Grabbe, E., and Becker, W.: 67Ga-citrate and 99Tcm-MDP for estimating the severity of vertebral osteomyelitis, Nucl. Med. Commun., 21, 111–120, https://doi.org/10.1097/00006231-200001000-00018, 2000.
Gratz, S., Dörner, J., Fischer, U., Behr, T., Béhé, M., Altenvoerde, G., Meller, J., Grabbe, E., and Becker, W.: 18F-FDG hybrid PET in patients with suspected spondylitis, Eur. J. Nucl. Med., 29, 516–524, https://doi.org/10.1007/s00259-001-0719-8, 2002.
Gupta, A., Kowalski, T. J., Osmon, D. R., Enzler, M., Steckelberg, J. M.,
Huddleston, P. M., Nassr, A., Mandrekar, J. M., and Berbari, E. F.:
Long-Term Outcome of Pyogenic Vertebral Osteomyelitis: A Cohort Study of 260
Patients, Open Forum Infect. Dis., 1, ofu107,
https://doi.org/10.1093/ofid/ofu107, 2014.
Hadjipavlou, A. G., Cesani-Vazquez, F., Villaneuva-Meyer, J., Mader, J. T.,
Necessary, J. T., Crow, W., Jensen, R. E., and Chaljub, G.: The
effectiveness of gallium citrate Ga 67 radionuclide imaging in vertebral
osteomyelitis revisited, Am. J. Orthop. Belle Mead NJ, 27, 179–183, 1998.
Held, M., Laubscher, M., Zar, H. J., and Dunn, R. N.: GeneXpert polymerase
chain reaction for spinal tuberculosis: an accurate and rapid diagnostic
test, Bone Joint J., 96-B, 1366–1369,
https://doi.org/10.1302/0301-620X.96B10.34048, 2014.
Heyer, C. M., Brus, L.-J., Peters, S. A., and Lemburg, S. P.: Efficacy of
CT-guided biopsies of the spine in patients with spondylitis – an analysis
of 164 procedures, Eur. J. Radiol., 81, e244–e249,
https://doi.org/10.1016/j.ejrad.2011.02.007, 2012.
Homagk, L., Marmelstein, D., Homagk, N., and Hofmann, G. O.: SponDT
(Spondylodiscitis Diagnosis and Treatment): spondylodiscitis scoring system,
J. Orthop. Surg., 14, 100, https://doi.org/10.1186/s13018-019-1134-9, 2019.
Hong, S. H., Choi, J.-Y., Lee, J. W., Kim, N. R., Choi, J.-A., and Kang, H.
S.: MR Imaging Assessment of the Spine: Infection or an Imitation?,
RadioGraphics, 29, 599–612, https://doi.org/10.1148/rg.292085137, 2009.
Huang, Z., Zhang, Z., Yang, B., Li, W., Zhang, C., Fang, X., Zhang, C.,
Zhang, W., and Lin, J.: Pathogenic Detection by Metagenomic Next-Generation
Sequencing in Osteoarticular Infections, Front. Cell. Infect. Mi.,
10, 471, https://doi.org/10.3389/fcimb.2020.00471, 2020.
Husseini, J. S., Simeone, F. J., Nelson, S. B., and Chang, C. Y.: CT-guided
discitis-osteomyelitis biopsies: needle gauge and microbiology results,
Skeletal Radiol., 49, 1431–1439,
https://doi.org/10.1007/s00256-020-03439-3, 2020.
Issa, K., Diebo, B. G., Faloon, M., Naziri, Q., Pourtaheri, S., Paulino, C.
B., and Emami, A.: The Epidemiology of Vertebral Osteomyelitis in the United
States From 1998 to 2013, Clin. Spine Surg. Spine Publ., 31, E102–E108,
https://doi.org/10.1097/BSD.0000000000000597, 2018.
Iwata, E., Scarborough, M., Bowden, G., McNally, M., Tanaka, Y., and
Athanasou, N. A.: The role of histology in the diagnosis of
spondylodiscitis: correlation with clinical and microbiological findings,
Bone Joint J., 101-B, 246–252,
https://doi.org/10.1302/0301-620X.101B3.BJJ-2018-0491.R2, 2019.
Jean, M., Irisson, J.-O., Gras, G., Bouchand, F., Simo, D., Duran, C.,
Perronne, C., Mulleman, D., Bernard, L., and Dinh, A.: Diagnostic delay of
pyogenic vertebral osteomyelitis and its associated factors, Scand. J.
Rheumatol., 46, 64–68, https://doi.org/10.3109/03009742.2016.1158314, 2017.
Kamiya, N., Hatakeyama, S., Kanda, N., Yonaha, S., Akine, D., Yamamoto, Y.,
and Matsumura, M.: Significance of repeat magnetic resonance imaging in
diagnosing vertebral osteomyelitis, J. Gen. Fam. Med., 20, 68–71,
https://doi.org/10.1002/jgf2.226, 2019.
Kihira, S., Koo, C., Mahmoudi, K., Leong, T., Mei, X., Rigney, B., Aggarwal,
A., and Doshi, A. H.: Combination of Imaging Features and Clinical
Biomarkers Predicts Positive Pathology and Microbiology Findings Suggestive
of Spondylodiscitis in Patients Undergoing Image-Guided Percutaneous Biopsy,
Am. J. Neuroradiol., 41, 1316–1322, https://doi.org/10.3174/ajnr.A6623,
2020.
Kim, B. J., Lee, J. W., Kim, S. J., Lee, G. Y., and Kang, H. S.: Diagnostic
Yield of Fluoroscopy-Guided Biopsy for Infectious Spondylitis, Am. J.
Neuroradiol., 34, 233–238, https://doi.org/10.3174/ajnr.A3120, 2013.
Kouijzer, I. J. E., Scheper, H., de Rooy, J. W. J., Bloem, J. L., Janssen,
M. J. R., van den Hoven, L., Hosman, A. J. F., Visser, L. G., Oyen, W. J.
G., Bleeker-Rovers, C. P., and de Geus-Oei, L.-F.: The diagnostic value of
18F–FDG-PET/CT and MRI in suspected vertebral osteomyelitis – a
prospective study, Eur. J. Nucl. Med. Mol. I., 45, 798–805,
https://doi.org/10.1007/s00259-017-3912-0, 2018.
Kowalski, T. J., Layton, K. F., Berbari, E. F., Steckelberg, J. M.,
Huddleston, P. M., Wald, J. T., and Osmon, D. R.: Follow-Up MR Imaging in
Patients with Pyogenic Spine Infections: Lack of Correlation with Clinical
Features, Am. J. Neuroradiol., 28, 693–699, 2007.
Lecouvet, F., Irenge, L., Vandercam, B., Nzeusseu, A., Hamels, S., and Gala,
J.-L.: The etiologic diagnosis of infectious discitis is improved by
amplification-based DNA analysis, Arthritis Rheum., 50, 2985–2994,
https://doi.org/10.1002/art.20462, 2004.
Ledermann, H. P., Schweitzer, M. E., Morrison, W. B., and Carrino, J. A.: MR Imaging Findings in Spinal Infections: Rules or Myths?, Radiology, 228, 506–514, https://doi.org/10.1148/radiol.2282020752, 2003.
Lefterova, M. I., Suarez, C. J., Banaei, N., and Pinsky, B. A.:
Next-Generation Sequencing for Infectious Disease Diagnosis and Management,
J. Mol. Diagn., 17, 623–634, https://doi.org/10.1016/j.jmoldx.2015.07.004,
2015.
Lisbona, R., Derbekyan, V., Novales-Diaz, J., and Veksler, A.: Gallium-67 Scintigraphy in Tuberculous and Nontuberculous Infectious Spondylitis, J. Nucl. Med., 34, 853–859, 1993.
Love, C., Patel, M., Lonner, B. S., Tomas, M. B., and Palestro, C. J.:
Diagnosing Spinal Osteomyelitis: A Comparison of Bone and Ga-67 Scintigraphy
and Magnetic Resonance Imaging, Clin. Nucl. Med., 25, 963–977, https://doi.org/10.1097/00003072-200012000-00002, 2000.
Maurer, A. H., Chen, D. C., Camargo, E. E., Wong, D. F., Wagner, H. N. J.,
and Alderson, P. O.: Utility of three-phase skeletal scintigraphy in
suspected osteomyelitis: concise communication., J. Nucl. Med. Off. Publ.
Soc. Nucl. Med., 22, 941–949, 1981.
Mavrogenis, A. F., Megaloikonomos, P. D., Igoumenou, V. G., Panagopoulos, G.
N., Giannitsioti, E., Papadopoulos, A., and Papagelopoulos, P. J.:
Spondylodiscitis revisited, EFORT Open Rev., 2, 447–461,
https://doi.org/10.1302/2058-5241.2.160062, 2017.
McHenry, M. C., Easley, K. A., and Locker, G. A.: Vertebral Osteomyelitis:
Long-Term Outcome for 253 Patients from 7 Cleveland-Area Hospitals, Clin.
Infect. Dis., 34, 1342–1350, https://doi.org/10.1086/340102, 2002.
McNamara, A. L., Dickerson, E. C., Gomez-Hassan, D. M., Cinti, S. K., and
Srinivasan, A.: Yield of Image-Guided Needle Biopsy for Infectious Discitis:
A Systematic Review and Meta-Analysis, Am. J. Neuroradiol., 38, 2021–2027,
https://doi.org/10.3174/ajnr.A5337, 2017.
Modic, M. T., Feiglin, D. H., Piraino, D. W., Boumphrey, F., Weinstein, M.
A., Duchesneau, P. M., and Rehm, S.: Vertebral osteomyelitis: assessment
using MR, Radiology, 157, 157–166,
https://doi.org/10.1148/radiology.157.1.3875878, 1985.
Morales, H.: Infectious Spondylitis Mimics: Mechanisms of Disease and
Imaging Findings, Semin, Ultrasound CT MRI, 39, 587–604,
https://doi.org/10.1053/j.sult.2018.11.006, 2018.
Morcrette, H., Morgan, M. S., Farbos, A., O'Neill, P., Moore, K., Titball,
R. W., and Studholme, D. J.: Genome Sequence of Staphylococcus aureus Ex1,
Isolated from a Patient with Spinal Osteomyelitis, Genome Announc., 6, 1–2,
https://doi.org/10.1128/genomeA.00623-18, 2018.
Mylona, E., Samarkos, M., Kakalou, E., Fanourgiakis, P., and Skoutelis, A.:
Pyogenic Vertebral Osteomyelitis: A Systematic Review of Clinical
Characteristics, Semin. Arthritis Rheum., 39, 10–17,
https://doi.org/10.1016/j.semarthrit.2008.03.002, 2009.
Nakahara, M., Ito, M., Hattori, N., Magota, K., Takahata, M., Nagahama, K., Sudo, H., Kamishima, T., Tamaki, N., and Iwasaki, N.: 18F-FDG-PET/CT better localizes active spinal infection than MRI for successful minimally invasive surgery, Acta Radiol., 56, 829–836, https://doi.org/10.1177/0284185114541983, 2015.
Nolla, J. M., Ariza, J., Gómez-Vaquero, C., Fiter, J., Bermejo, J., Valverde, J., Escofet, D. R., and Gudiol, F.: Spontaneous pyogenic vertebral osteomyelitis in nondrug users, Semin. Arthritis Rheu., 31, 271–278, https://doi.org/10.1053/sarh.2002.29492, 2002.
Nolla-Solé, J. M., Mateo-Soria, L., Rozadilla-Sacanell, A., Mora-Salvador, J., Valverde-Garcia, J., and Roig-Escofet, D.: Role of technetium-99m diphosphonate and gallium-67 citrate bone scanning in the early diagnosis of infectious spondylodiscitis. A comparative study., Ann. Rheum. Dis., 51, 665–667, https://doi.org/10.1136/ard.51.5.665, 1992.
Osenbach, R. K., Hitchon, P. W., and Menezes, A. H.: Diagnosis and management of pyogenic vertebral osteomyelitis in adults, Surg. Neurol., 33, 266–275, https://doi.org/10.1016/0090-3019(90)90047-S, 1990.
Pandita, N., Paul, S., Yadav, G., Kalia, R. B., and Kandwal, P.: Evaluation
of Challenges in Diagnosis of Spontaneous Subacute Pyogenic Spondylodiscitis
in Immunocompetent Patients: Experiences from a Tertiary Care Center, Asian
Spine J., 13, 621–629, https://doi.org/10.31616/asj.2018.0220, 2019.
Patel, K. B., Poplawski, M. M., Pawha, P. S., Naidich, T. P., and Tanenbaum,
L. N.: Diffusion-Weighted MRI “Claw Sign” Improves Differentiation of
Infectious from Degenerative Modic Type 1 Signal Changes of the Spine, Am.
J. Neuroradiol., 35, 1647–1652, https://doi.org/10.3174/ajnr.A3948, 2014.
Patzakis, M. J., Rao, S., Wilkins, J., Moore, T. M., and Harvey, P. J.: Analysis of 61 cases of vertebral osteomyelitis, Clin. Orthop. Relat. Res., 264, 178–183, 1991.
Pineda, C., Espinosa, R., and Pena, A.: Radiographic Imaging in
Osteomyelitis: The Role of Plain Radiography, Computed Tomography,
Ultrasonography, Magnetic Resonance Imaging, and Scintigraphy, Semin. Plast.
Surg., 23, 080–089, https://doi.org/10.1055/s-0029-1214160, 2009.
Prodi, E., Grassi, R., Iacobellis, F., and Cianfoni, A.: Imaging in
Spondylodiskitis, Magn. Reson. Imaging C., 24, 581–600,
https://doi.org/10.1016/j.mric.2016.04.005, 2016.
Pupaibool, J., Vasoo, S., Erwin, P. J., Murad, M. H., and Berbari, E. F.:
The utility of image-guided percutaneous needle aspiration biopsy for the
diagnosis of spontaneous vertebral osteomyelitis: a systematic review and
meta-analysis, Spine J., 15, 122–131,
https://doi.org/10.1016/j.spinee.2014.07.003, 2015.
Salaffi, F., Ceccarelli, L., Carotti, M., Di Carlo, M., Polonara, G.,
Facchini, G., Golfieri, R., and Giovagnoni, A.: Differentiation between
infectious spondylodiscitis versus inflammatory or degenerative spinal
changes: How can magnetic resonance imaging help the clinician?, Radiol.
Med., 126, 843–859, https://doi.org/10.1007/s11547-021-01347-7,
2021.
Salipante, S. J., Sengupta, D. J., Rosenthal, C., Costa, G., Spangler, J.,
Sims, E. H., Jacobs, M. A., Miller, S. I., Hoogestraat, D. R., Cookson, B.
T., McCoy, C., Matsen, F. A., Shendure, J., Lee, C. C., Harkins, T. T., and
Hoffman, N. G.: Rapid 16S rRNA Next-Generation Sequencing of Polymicrobial
Clinical Samples for Diagnosis of Complex Bacterial Infections, Plos One, 8,
e65226, https://doi.org/10.1371/journal.pone.0065226, 2013.
Sheikh, A. F., Khosravi, A. D., Goodarzi, H., Nashibi, R., Teimouri, A.,
Motamedfar, A., Ranjbar, R., Afzalzadeh, S., Cyrus, M., and Hashemzadeh, M.:
Pathogen Identification in Suspected Cases of Pyogenic Spondylodiscitis,
Front. Cell. Infect. Mi., 7, 60,
https://doi.org/10.3389/fcimb.2017.00060, 2017.
Smids, C., Kouijzer, I. J. E., Vos, F. J., Sprong, T., Hosman, A. J. F., de Rooy, J. W. J., Aarntzen, E. H. J. G., de Geus-Oei, L.-F., Oyen, W. J. G., and Bleeker-Rovers, C. P.: A comparison of the diagnostic value of MRI and 18F-FDG-PET/CT in suspected spondylodiscitis, Infection, 45, 41–49, https://doi.org/10.1007/s15010-016-0914-y, 2017.
Sobottke, R., Seifert, H., Fätkenheuer, G., Schmidt, M., Goßmann,
A., and Eysel, P.: Current Diagnosis and Treatment of Spondylodiscitis,
Dtsch. Aerzteblatt Online, 105, 181–187, https://doi.org/10.3238/arztebl.2008.0181, 2008.
Tali, E. T., Koc, A. M., and Oner, A. Y.: Spinal Brucellosis, Neuroimaging
Clin. N. Am., 25, 233–245, https://doi.org/10.1016/j.nic.2015.01.004, 2015.
Tamm, A. S. and Abele, J. T.: Bone and Gallium Single-Photon Emission
Computed Tomography-Computed Tomography is Equivalent to Magnetic Resonance
Imaging in the Diagnosis of Infectious Spondylodiscitis: A Retrospective
Study, Can. Assoc. Radiol. J., 68, 41–46,
https://doi.org/10.1016/j.carj.2016.02.003, 2017.
Torda, A. J., Gottlieb, T., and Bradbury, R.: Pyogenic Vertebral Osteomyelitis: Analysis of 20 Cases and Review, Clin. Infect. Dis., 20, 320–328, https://doi.org/10.1093/clinids/20.2.320, 1995.
Waheed, G., Soliman, M. A. R., Ali, A. M., and Aly, M. H.: Spontaneous
spondylodiscitis: review, incidence, management, and clinical outcome in 44
patients, Neurosurg. Focus, 46, E10,
https://doi.org/10.3171/2018.10.FOCUS18463, 2019.
Wong, D., Holtom, P., and Spellberg, B.: Osteomyelitis Complicating Sacral
Pressure Ulcers: Whether or Not to Treat With Antibiotic Therapy, Clin.
Infect. Dis., 68, 338–342, https://doi.org/10.1093/cid/ciy559, 2019.
Wong, H., Tarr, G. P., Rajpal, K., Sweetman, L., and Doyle, A.: The impact
of antibiotic pre-treatment on diagnostic yield of CT-guided biopsy for
spondylodiscitis: A multi-centre retrospective study and meta-analysis, J.
Med. Imaging Radiat. Oncol., 65, 146–151,
https://doi.org/10.1111/1754-9485.13118, 2021.
Wu, H.-T. H., Chang, C.-Y., Chang, H., Yen, C.-C., Cheng, H., Chen, P.
C.-S., and Chiou, H.-J.: Magnetic resonance imaging guided biopsy of
musculoskeletal lesions, J. Chin. Med. Assoc., 75, 160–166,
https://doi.org/10.1016/j.jcma.2012.02.008, 2012.
Yeh, K. J., Husseini, J. S., Hemke, R., Nelson, S. B., and Chang, C. Y.:
CT-guided discitis-osteomyelitis biopsies with negative microbiology: how
many days should we wait before repeating the biopsy?, Skeletal Radiol., 49,
619–623, https://doi.org/10.1007/s00256-019-03344-4, 2020.
Zarrouk, V., Feydy, A., Salles, F., Dufour, V., Guigui, P., Redondo, A., and Fantin, B.: Imaging does not predict the clinical outcome of bacterial vertebral osteomyelitis, Rheumatology, 46, 292–295, https://doi.org/10.1093/rheumatology/kel228, 2006.
Zimmerli, W.: Vertebral Osteomyelitis, N. Engl. J. Med., 362, 1022–1029,
https://doi.org/10.1056/NEJMcp0910753, 2010.
Short summary
The yearly incidence of native vertebral osteomyelitis (NVO) is increasing. In 2013 the prevalence of NVO in the USA was 5.4 cases per 100 000. Delays in the diagnosis of NVO remain common, in part due to the insidious nature of the infection and its related symptoms. The mean time between the onset of symptoms to diagnosis of NVO is 45.5 d. We herein review available and novel diagnostic modalities at the disposal of healthcare providers to reach an accurate and timely diagnosis of NVO.
The yearly incidence of native vertebral osteomyelitis (NVO) is increasing. In 2013 the...
