Article Figures & Data
Figures
- Fig 1.
A 35-year-old woman with neck pain and a sense of heat in both shoulders for 6 months. A, Sagittal T2-weighted MR image shows low signal change with upper endplate destruction at the C6 upper body. Percutaneous biopsy was performed at the C6 upper body with a right unilateral anterior approach under fluoroscopic guidance, which is seen on anteroposterior (B) and lateral (C) spot radiographs. Biopsy was confirmed as chronic osteomyelitis, but the causative organism was not isolated.
- Fig 2.
A 69-year-old man with fever 15 days after an operation for mechanical obstruction. Sagittal T1-weighted (A) and enhancement (B) MR images show low bone marrow signal change with enhancement at T12 and the L1 body and abscess formation at the anterior epidural space of the T12-L1 level. Percutaneous biopsy was performed at the T12 lower body with a left unilateral transpedicular approach under fluoroscopic guidance, which is demonstrated on anteroposterior (C) and lateral (D) spot radiographs. Pathologic findings were consistent with infectious spondylitis. The isolated causative organism was Klebsiella pneumoniae.
- Fig 3.
A 53-year-old man with low back pain and a chilling sensation for 1 week. Sagittal T1- (A), T2- (B), and axial T2-weighted (C) MR images show T2 high-fluid signal intensity in the L5/S1 disk space with T1 low marrow signal change in the peripheral portion of the L5 lower and S1 upper bodies and paravertebral extension. As seen on anteroposterior (D) and lateral (E and F) spot radiographs, percutaneous biopsy and disk aspiration were performed at the left inferior lower body of the L5 vertebra with a left unilateral transpedicular approach under fluoroscopic guidance. Biopsy confirmed infectious spondylitis, but the causative organism was not isolated. After empiric antibiotic treatment, clinical symptoms were improved.
Tables
Level No. Cervical spine 1 Thoracic spine 22 Lumbar spine 147 Total 170 No. Histology(+) 115 Culture(+) 51 Culture(−) 64 Histology(−) 55 Infection 32 Noninfection 13 Follow-up loss 1 Inadequate specimen 5 Etc 4 Total 170 Note:—Etc. indicates the case that infectious spondylitis was suspected on MRI image, but clinical symptoms were improved without empirical antibiotic treatment.
↵a For Histology(+), the pathology report was recorded as follows: “consistent with infectious spondylitis,” “active or acute inflammation,” “suggestive of osteomyelitis,” “chronic granulomatous inflammation.” Histology(−) is the rest except the histology(+). Culture(+) indicates cases of identification of the causative organism. Culture(−) is cases of no identification of the causative organism.
Histology(+), Culture(−) Culture(−) Infection 53 30 Confirmed by operation 13 4 Isolation of the causative organism by blood culture 12 5 Improvement after empiric antibiotic treatment 25 19 Aggravation on follow-up MRI 3 1 Noninfection 11 20 Compression fracture 6 7 Degenerative change (Modic type I) 2 3 Hemorrhage by previous trauma 0 2 CML 0 1 Follow-up loss 1 1 Etc 2 6 64 50 Note:—Etc. indicates the case that infectious spondylitis was suspected on MRI image, but clinical symptoms were improved without empirical antibiotic treatment; CML, chronic myelomonocytic leukemia.
↵a For Histology(+), the pathology report was recorded as “consistent with infectious spondylitis, “active or acute inflammation,” “suggestive of osteomyelitis,” and “chronic granulomatous inflammation.” Histology(−) indicates the rest except the histology(+). Culture(+) is identification of the causative organism. Culture(−) is no identification of the causative organism.
