Analysis of results of open and percutaneous disc biopsy in the diagnosis of spondylodiscitis. / Análisis de los resultados de la biopsia discal abierta y percutánea en el diagnóstico de la espondilodiscitis.

INTRODUCTION: Spinal disc biopsy is a necessary tool in diagnosing and treating spondylodiscitis. Its profitability varies according to the technique, concomitant antibiotics therapy or causative germ. We studied the results of this procedure in our institution. MATERIALS AND METHODS: Retrospective analysis of all cases requiring disc biopsy due to possible spondylodiscitis over a 5year period, both percutaneous (26 cases) and open (13 cases). We collected filiation and clinical data, comorbidity, concomitant antibiotic therapy, imaging tests, biopsy type, cultures results and clinical evolution. RESULTS: 39 patients; 66.7% male, 66.9years of average age. 74% has known risk factors. The main symptom was pain (89.7%). Fever occurred in 5%. MRI performed in 87%. Lumbar involvement in 76.9%. 9 patients (23%) received antibiotic treatment simultaneously with biopsy. In these cases biopsy always yielded a negative result, but positive in patients without antibiotics at the time of the biopsy (53.3%), with statistical significance. Most frequent isolated microorganisms were gram-negative bacilli (31.2%) and gram-positive cocci (31.2%). We found 2 deaths during admission for sepsis (within the first month after diagnosis). Of the rest of patients, 5 died late during the follow-up: 3 due to new infections and 2 due to subsequent complications of previous pathologies. The remaining patients with final diagnosis of spondylodiscitis evolved satisfactorily with antibiotic therapy. CONCLUSIONS: Spondylodiscitis is potentially serious and requires an adequate diagnosis, with disc biopsy being a necessary procedure on occasions. Patients poor clinical condition can make it impossible to withdraw antibiotics, which drastically reduces the performance of the biopsy.

Analysis of results of open and percutaneous disc biopsy in the diagnosis of spondylodiscitis / Análisis de los resultados de la biopsia discal abierta y percutánea en el diagnóstico de la espondilodiscitis

Introduction: Spinal disc biopsy is a necessary tool in diagnosing and treating spondylodiscitis. Its profitability varies according to the technique, concomitant antibiotics therapy or causative germ. We studied the results of this procedure in our institution.Materials and methods: Retrospective analysis of all cases requiring disc biopsy due to possible spondylodiscitis over a 5year period, both percutaneous (26 cases) and open (13 cases). We collected filiation and clinical data, comorbidity, concomitant antibiotic therapy, imaging tests, biopsy type, cultures results and clinical evolution. Results: 39 patients; 66.7% male, 66.9years of average age. 74% has known risk factors. The main symptom was pain (89.7%). Fever occurred in 5%. MRI performed in 87%. Lumbar involvement in 76.9%. 9 patients (23%) received antibiotic treatment simultaneously with biopsy. In these cases biopsy always yielded a negative result, but positive in patients without antibiotics at the time of the biopsy (53.3%), with statistical significance. Most frequent isolated microorganisms were gram-negative bacilli (31.2%) and gram-positive cocci (31.2%). We found 2 deaths during admission for sepsis (within the first month after diagnosis). Of the rest of patients, 5 died late during the follow-up: 3 due to new infections and 2 due to subsequent complications of previous pathologies. The remaining patients with final diagnosis of spondylodiscitis evolved satisfactorily with antibiotic therapy. Conclusions: Spondylodiscitis is potentially serious and requires an adequate diagnosis, with disc biopsy being a necessary procedure on occasions. Patients poor clinical condition can make it impossible to withdraw antibiotics, which drastically reduces the performance of the biopsy.(AU)

Introducción: La biopsia discal es una herramienta necesaria en el proceso diagnóstico y terapéutico de las espondilodiscitis. Su rentabilidad es variable según condicionantes como la técnica utilizada, el uso concomitante de antibióticos o el germen causante. Estudiamos los resultados de este procedimiento en nuestro centro en un periodo de 5años. Material y métodos: Análisis retrospectivo de todos los casos que requirieron biopsia discal por posible espondilodiscitis en nuestro centro entre enero de 2015 y noviembre de 2019, tanto percutánea (26 casos) como abierta (13 casos). Recogemos datos de filiación y clínicos, comorbilidad, antibioterapia concomitante, pruebas de imagen, tipo de biopsia, resultado de cultivos y evolución clínica. Resultados: Treinta y nueve pacientes: 66,7% varones, 66,9años de edad media. El 74% con factores de riesgo conocidos. El síntoma principal es dolor mayoritariamente (89,7%) y fiebre en el 5%. La RMN en la prueba más frecuentemente realizada (87%). Los segmentos lumbares se afectaron en el 76,9%, por el 23% los dorsales. En 9 casos (23%) los pacientes reciben tratamiento antibiótico simultáneamente a la realización de la biopsia. En estos casos la biopsia siempre arrojó un resultado negativo. Los cultivos fueron positivos más frecuentemente en los pacientes sin antibióticos en el momento de la biopsia (53,3%), con significación estadística. Los microorganismos aislados de manera más repetida fueron los bacilos gramnegativos (31,2%) y los cocos grampositivos (31,2%). Constatamos 2 fallecimientos durante el ingreso por sepsis (dentro del primer mes tras el diagnóstico). Del resto de los pacientes fallecieron 5 de manera tardía durante el seguimiento: 3 por nuevas infecciones complicadas de manera tardía y 2 por complicaciones ulteriores de patologías previas. El resto de pacientes con diagnóstico final de espondilodiscitis evolucionaron satisfactoriamente con antibioterapia.(AU)

Análisis de los resultados de la biopsia discal abierta y percutánea en el diagnóstico de la espondilodiscitis / Analysis of results of open and percutaneous disc biopsy in the diagnosis of spondylodiscitis

Introducción: La biopsia discal es una herramienta necesaria en el proceso diagnóstico y terapéutico de las espondilodiscitis. Su rentabilidad es variable según condicionantes como la técnica utilizada, el uso concomitante de antibióticos o el germen causante. Estudiamos los resultados de este procedimiento en nuestro centro en un periodo de 5años. Material y métodos: Análisis retrospectivo de todos los casos que requirieron biopsia discal por posible espondilodiscitis en nuestro centro entre enero de 2015 y noviembre de 2019, tanto percutánea (26 casos) como abierta (13 casos). Recogemos datos de filiación y clínicos, comorbilidad, antibioterapia concomitante, pruebas de imagen, tipo de biopsia, resultado de cultivos y evolución clínica. Resultados: Treinta y nueve pacientes: 66,7% varones, 66,9años de edad media. El 74% con factores de riesgo conocidos. El síntoma principal es dolor mayoritariamente (89,7%) y fiebre en el 5%. La RMN en la prueba más frecuentemente realizada (87%). Los segmentos lumbares se afectaron en el 76,9%, por el 23% los dorsales. En 9 casos (23%) los pacientes reciben tratamiento antibiótico simultáneamente a la realización de la biopsia. En estos casos la biopsia siempre arrojó un resultado negativo. Los cultivos fueron positivos más frecuentemente en los pacientes sin antibióticos en el momento de la biopsia (53,3%), con significación estadística. Los microorganismos aislados de manera más repetida fueron los bacilos gramnegativos (31,2%) y los cocos grampositivos (31,2%). Constatamos 2 fallecimientos durante el ingreso por sepsis (dentro del primer mes tras el diagnóstico). Del resto de los pacientes fallecieron 5 de manera tardía durante el seguimiento: 3 por nuevas infecciones complicadas de manera tardía y 2 por complicaciones ulteriores de patologías previas. El resto de pacientes con diagnóstico final de espondilodiscitis evolucionaron satisfactoriamente con antibioterapia.(AU)

Introduction: Spinal disc biopsy is a necessary tool in diagnosing and treating spondylodiscitis. Its profitability varies according to the technique, concomitant antibiotics therapy or causative germ. We studied the results of this procedure in our institution.Materials and methods: Retrospective analysis of all cases requiring disc biopsy due to possible spondylodiscitis over a 5year period, both percutaneous (26 cases) and open (13 cases). We collected filiation and clinical data, comorbidity, concomitant antibiotic therapy, imaging tests, biopsy type, cultures results and clinical evolution. Results: 39 patients; 66.7% male, 66.9years of average age. 74% has known risk factors. The main symptom was pain (89.7%). Fever occurred in 5%. MRI performed in 87%. Lumbar involvement in 76.9%. 9 patients (23%) received antibiotic treatment simultaneously with biopsy. In these cases biopsy always yielded a negative result, but positive in patients without antibiotics at the time of the biopsy (53.3%), with statistical significance. Most frequent isolated microorganisms were gram-negative bacilli (31.2%) and gram-positive cocci (31.2%). We found 2 deaths during admission for sepsis (within the first month after diagnosis). Of the rest of patients, 5 died late during the follow-up: 3 due to new infections and 2 due to subsequent complications of previous pathologies. The remaining patients with final diagnosis of spondylodiscitis evolved satisfactorily with antibiotic therapy. Conclusions: Spondylodiscitis is potentially serious and requires an adequate diagnosis, with disc biopsy being a necessary procedure on occasions. Patients poor clinical condition can make it impossible to withdraw antibiotics, which drastically reduces the performance of the biopsy.(AU)

Outcomes of vertebroplasty in osteoporotic vertebral fractures with limited indication. / Resultados de la vertebroplastia en fracturas vertebrales osteoporóticas con indicación límite.

INTRODUCTION: Vertebroplasty has been shown to be effective for improving quality of life and pain of osteoporotic vertebral fractures (OVF) without neurological deficit and not susceptible to conservative treatment. It is advisable to perform them on recent fractures with 50% crush and without the involvement of the canal, although there are no standard recommendations. In some cases these limits are exceeded. We analyse the outcomes of percutaneous vertebroplasty (PVP) in OVF with relative/limit indication. MATERIALS AND METHODS: Retrospective analysis of 88 patients (126 fractures) who underwent surgery by PVP; 95/126 were osteoporotic fractures. Thirty-four cases (35%) were included in the relative indication group, with at least one of the following: canal involvement,>50% collapse, and>12 months of evolution of the fracture. The rest of the cases were included in the standard indication group. We performed clinical-radiological follow-up, collected intraoperative data on techniques and complications, occurrence of leaks, postoperative clinical improvement (according to VAS), new adjacent fractures, and satisfaction. RESULTS: Most fractures were between D11-L2 (66%) with 6-8 months follow-up. No significant differences were observed regarding clinical improvement in either group. A higher percentage of leaks were detected in the relative indication group, 44% in comparison to 29.5% in the standard indication group, without statistical significance. All leakages were asymptomatic. There were 3new OVF after PVP in the relative indication group and 4in the standard group, without statistically significant differences. DISCUSSION AND CONCLUSIONS: The use of cement in OVF with relative indication led to the same clinical benefit in our sample as those with standard indication. A higher number of leakages occurred in the relative indication group with no clinical consequences or adjacent fractures.