Single Sequence Whole-Spine Screening Magnetic Resonance Imaging: Diagnostic and Therapeutic Role in Multiple-Level Spinal Tuberculosis.

INTRODUCTION: Spinal tuberculosis (TB) is the most common form of skeletal tuberculosis. Paradiscal continuous vertebral involvement at a single level is the most prevalent pattern among all forms of spinal TB. There is a wide range of reported incidences of multiple-level non-contiguous spinal TB in the literature. We would like to discuss on the utility of single whole spine screening T2-weighted (T2W) mid-sagittal magnetic resonance imaging (MRI) film in diagnosing multiple-level spinal TB and therapeutic benefits it can provide. METHODS: We have done a retrospective review of the collected data of patients in Vardhman Mahavir Medical College and Safdarjung Hospital from August 2017 to October 2021 to find the incidence of multiple-level spinal TB and possible factors attributed to this specific disease pattern. All the patients who had been diagnosed of spinal TB either microbiologically or histopathologically or by a good clinical response to anti-tubercular treatment (ATT) and had a whole spine screening MRI film, were included. Patients of spinal TB who did not have a whole spine screening MRI were excluded from the study. Multiple-level spinal TB was diagnosed when lesions were identified in vertebral levels other than a typical paradiscal lesion, and additional lesions were separated from the primary disease by at least one normal spinal segment. RESULTS: Among the patients, 242 met the inclusion criteria, and 76 showed multiple-level non-contiguous spinal TB on MRI, incidence being 31.4%. The rest of the 166 patients showed typical single-segment contiguous lesions. By doing multivariate analysis to determine the independent risk factors for multiple-level spinal TB, extremes of age (<20 years and >50 years) have been found to be a significant factor with p value of 0.0001. Though drug resistance was not found to be a significant risk factor (p value 0.051), the proportion of patients having multiple-level TB was far more in the drug-resistant group (13/76). CONCLUSIONS: Single sequence whole spine screening MRI film is an effective, economical, and time-saving tool to detect multiple-level spinal TB. Along with its diagnostic accuracy, it also provides therapeutic benefits like access to a more approachable site for biopsy.

Computed Tomography-Guided Spinal Biopsy in Suspected Infective Spondylodiscitis: An Institutional Review of Its Utility.

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.

Modified percutaneous biopsy of the spine: improvement of the technique.

PURPOSE: Biopsy of the spine can be performed by open surgery or percutaneous needle sampling. The first has the highest diagnostic yield while the second is a less invasive procedure with lower rate of complications and shorter hospitalization time. We described a modified technique of percutaneous biopsy using semi-rigid grasping forceps that may offer the advantages of both, open and minimally invasive surgery. METHODS: Thirty consecutive patients with spinal lesions requiring biopsy were admitted to Neurosurgical Unit of Belcolle Hospital (Viterbo, Italy) from January 2017 to September 2021. There was a suspicion of spondylodiscitis in 25 cases and of tumor in 5 cases. Percutanous trans-pedicular spine biopsy has been performed using this new semi-rigid grasping forceps. Combining the opening width, jaw length and full 360° rotation, the device allows a wide and precise sampling. RESULTS: Sampling was sufficient in all cases (100%); tumors was observed in 5 cases (16.7%%) with a percentage of definitive histopathologic diagnosis of 100% (n = 5); among the remaining patients histological examination yielded a diagnosis of spinal infection in 25 cases (100%), and microbiologic culture provided an aetiologic diagnosis in 23 cases (92%). All procedures were well tolerated, and no postoperative complications were observed. Levels involved included: thoracic (T5-T9) in 8 cases, thoracolumbar junction (T10-L2) in 12 cases and lumbar (L3-L5) in 10 cases. CONCLUSIONS: Percutaneous biopsy with the semi-rigid grasping forceps is a safe and effective procedure that can be used for diagnosis of both infectious and tumor lesions of the spine. It allows to obtain a larger specimen volume and to use a multidirectional trajectory for sampling, resulting in a minimally invasive technique with strong ability to yield etiologic diagnosis.

Diagnostic Accuracy and Adequacy of Computed Tomography Versus Fluoroscopy-Guided Percutaneous Transpedicular Biopsy of Spinal Lesions.

Background Transpedicular biopsy of spinal lesions is imperative for the generation of a definite diagnosis. Thus far, literature comparing the accuracy and adequacy between fluoroscopy-guided and computed tomography (CT)-guided transpedicular biopsy of spinal lesions is scarce. We aim to compare the accuracy and adequacy of samples collected with the two techniques at the largest tertiary hospital in Malaysia. Materials and methods A total of 60 patients (37 patients with spinal infection and 23 patients with spinal tumour) underwent percutaneous transpedicular biopsy of spinal lesions from January 2013 to December 2017 at a tertiary centre. Demographic data, biopsy method (fluoroscopy-guided and CT-guided), diagnosis, adequacy, and accuracy of samples obtained were assessed. Results Among the 60 samples obtained, only two samples (3.3%) were deemed inadequate. There were 10 biopsy samples (16.7%) that were inaccurate. There was no statistical difference between fluoroscopy-guided and CT-guided transpedicular biopsy in terms of accuracy (p = 0.731) and adequacy (p = 0.492). Conclusions Fluoroscopy-guided and CT-guided transpedicular biopsy of spinal lesions offer similar accuracy and adequacy. Fluoroscopy-guided biopsy of the spinal lesion will be an option for spine surgeons when CT-guided biopsy is not available.

Fluoroscopy-guided intervertebral disc biopsy with a coaxial drill system.

OBJECTIVES: Percutaneous biopsy of discitis-osteomyelitis is performed to isolate the causative microorganism and exclude alternative diagnoses. We compared drill-assisted and manual fluoroscopy-guided intervertebral disc biopsies with respect to conscious sedation requirements and histologic quality of obtained specimens. MATERIALS AND METHODS: Medical records of all single-level, fluoroscopy-guided intervertebral disc biopsies supervised by one of two musculoskeletal radiologists between January 2010 and March 2015 were reviewed. Duration and cumulative medication doses required for each biopsy were recorded. Pathology reports were reviewed to determine whether the obtained specimens were adequate for histopathologic evaluation. Microbiology reports were reviewed to determine whether the causative organism was isolated from the biopsy specimen. RESULTS: During the study period, 21 drill-assisted and 20 manual biopsies were performed. The median duration of conscious sedation for drill-assisted biopsies was 30 min (range, 17-40 min) compared with 39 min (range, 20-90 min) for manual biopsies (p < 0.01). Drill-assisted biopsies also required lower median cumulative doses of intravenous midazolam [2 mg (range, 0-5 mg) vs. 3 mg (range, 0-9 mg); p = 0.02]. All drill-assisted biopsy specimens were adequate for histopathologic evaluation. One manual biopsy specimen (5 %; 1/20) was inadequate for histopathologic evaluation owing to crush artifact. The microbiology yields of drill-assisted and manual biopsies were comparable [14 % (3/21) vs. 20 % (4/20); p = 0.62]. CONCLUSIONS: Fluoroscopically-guided intervertebral disc biopsies performed with drill assistance require less conscious sedation compared with manual biopsies and yield specimens that are adequate for histopathologic evaluation.

The Diagnostic Usefulness of CT-guided Needle Biopsy or Aspiration in Infectious Spondylitis

PURPOSE: To determine the diagnostic value of CT-guided biopsy or aspiration of the spine and paraspinal soft tissue in infectious spondylitis. MATERIALS AND METHODS: Between January 2000 and June 2002, 58 patients underwent 67 biopsies and/or aspirations under CT guidance to identify the organism causing infectious spondylitis, and were included in this study. Nine underwent rebiopsy. In all patients, MR images were available before biopsy and/or aspiration. In 63 of 67 procedures, the specimens or aspirates obtained were prepared for culture and smear, and for histological examination, four procedures involved aspiration only. In ten patients with suspected tuberculosis, a polymerase chain reaction test was performed. For all procedures, the transpedicular, transcostovertebral or paravertebral route was involved, according to the level and shape of the lesions, and 14-, 16-, or 18-gauge core biopsy needles and/or 20-gauge aspiration needles were employed. Lesions invloved a paravertebral (n=17), psoas (n=8) or epidural (n=1) abscess; an intervertebral disc (n=20); or a vertebral body (n=21). The levels at the mid-thoracic spine were T4-T10 (n=11); at the thoracolumbar junction, T11-L1 (n=14); at the lumbar spine, L1-L4 (n=25); and at the lumbo-sacral junction, L5-S1 (n=17). In nine of 58 patients, rebiopsy was performed. RESULTS: Diagnosis was confirmed in 22 of 58 patients (38%), and was as follows: tuberculous spondylitis (n=17), pyogenic spondylitis (n=4), and fungal spondylitis (n=1). Thirty-six unconfirmed cases were diagnosed as nonspecific inflammation (n=21), fibrosis involving cortical bone (n=1), necrotic material (n=5) and inadequate specimen without evidence of malignancy (n=9). Only one of the nine cases in which biopsy was repeated was confirmed as tuberculous spondylitis. Diagnosis was confirmed in 7 of 17 paravertebral abscesses (41%), 8 of 21 vertebral bodies (38%), 6 of 20 intervertebral discs (30%) and 1 of 8 psoas abscesses (13%). CONCLUSION: In infectious spondylitis, the overall diagnostic yield of CT-guided needle biopsy and/or aspiration is relatively low, but the procedure seems to be effective for excluding malignancy. In identifying the organisms involved in infectious spondylitis, a paravertebral lesion is in a more favoured location than a psoas lesion.

Diagnostic Usefulness of CT-guided Pe rcutaneous Biopsy of the Spine

PURPOSE: To evaluate the diagnostic value of CT-guided percutaneous biopsy of inflammatory and tumorous lesions of the spine and paraspinal soft tissue. MATERIALS AND METHODS: Twenty-three patients underwent CT-guided percutaneous biopsy of the spine and paraspinal soft tissue. Tentative clinical diagnoses determined before biopsy were tuberculous spondylitis (n=5), pyogenic spondylitis (n=4), butterfly vertebra (n=1), old compression fracture (n=3), discitis (n=1), hemangioma (n=1), metastasis (n=7) and multiple myeloma (n=1). Biopsy was performed at the following levels: cervical-(n=1), thoracic-(n=9), and lumbar-spine(n=13). The approach to biopsy of the spine and paraspinal soft tissue lesions was posterolateral (n=11), posterior (n=2), or transpedicular (n=10). RESULTS: Tissue considered adequate by the pathologist involved was obtained in 21 (91%) of the 23 cases. In 19 cases, pathologic findings supported the clinical diagnoses determined before biopsy. In two cases, pathologic and clinical diagnoses differed. Complications such as severe pain, bleeding, infection, neurologic deficit or damage to internal organs were detected neither during or after the procedure. CONCLUSION: CT-guided percutaneous biopsy is a safe and reliable method of obtaining a diagnosis in many cases involving different spinal and paraspinal lesions.

CT-guided Percutaneous Biopsy of the Spine: Transpedicular approach

PURPOSE: To evaluate the efficiency of CT-guided transpedicular biopsy in obtaining diagnostic tissue fromvertebral body lesion. MATERIALS AND METHODS: The authors evaluated 25 patients(27 cases) who underwent CT-guidedtranspedicular biopsy for thoracic and lumbar vertebral lesions. Specimens were obtained from 27 lesions, sevenfrom thoracic spine and others from lumbar spine. Nine patients were men and 16 were women ; their ages rangedfrom 20 to 80 years. A 17-gauge "Osty-Cut" bone biopsy needle(Angiomed) with a hand-grip was used, and the patientwas placed in the prone position. For the analysis of results, pathologic reports were reviewed and follow-upstudies were checked. RESULTS: In all patients, the biopsy needle could be passed under CT guidance through thepedicle to the site of the disease. Pathologic reports indicated 11 malignancies, 11 normal trabecular bones andtwo cases of infectious spondylitis. Three cases were not diagnosed because of insufficient biopsy specimen. Eightcases of normal trabecular bone described in pathologic reports were confirmed by follow-up study. There were nocomplications during and after biopsy, and for pathologic diagnosis this was successful in 24 of 27 cases(88.9%). CONCLUSION: CT-guided transpedicular biopsy of vertebral lesion was safe and efficacious, especially in cases inwhich the posterolateral approach was difficult.