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Discitis-osteomyelitis: optimizing results of percutaneous sampling

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Abstract

Vertebral discitis-osteomyelitis is an infection of the spine that involves the intervertebral disc and the adjacent vertebral body but may also extend into the paraspinal and epidural soft tissues. If blood cultures and other culture data fail to identify a causative microorganism, percutaneous sampling is indicated to help guide targeted antimicrobial therapy. Despite limited supporting evidence, withholding antimicrobial therapy for up to 2 weeks is recommended to maximize microbiological yield, although literature supporting this recommendation is limited. During the procedure, technical factors that may improve yield include targeting of paraspinal fluid collections or soft tissue abnormalities for sampling, acquiring multiple core samples if possible, and use of larger gauge needles when available. Repeat sampling may be indicated if initial percutaneous biopsy is negative but should be performed no sooner than 72 h after the initial percutaneous biopsy to ensure adequate time for culture results to return.

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Authors and Affiliations

  1. Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA

    Jad S. Husseini & Ambrose J. Huang

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Key points

• Yield from biopsy of vertebral discitis-osteomyelitis is low.

• Technical factors that may improve yield include targeting paraspinal fluid and soft tissue abnormalities, collecting multiple core samples if feasible, and use of larger needle gauge.

• Although guidelines suggest holding antimicrobial therapy prior to biopsy, biopsy should be considered if cessation of antimicrobial treatment is not clinically reasonable.

• Repeat sampling can be considered in the setting of a negative initial biopsy but should be performed no sooner than 72 h from the initial biopsy.

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Husseini, J.S., Huang, A.J. Discitis-osteomyelitis: optimizing results of percutaneous sampling. Skeletal Radiol 52, 1815–1823 (2023). https://doi.org/10.1007/s00256-022-04151-0

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