Hamaguchi Sugihiro, Takahashi Sei, Endo Yuji, Nakamoto Yohei, Aita Tetsuro, Naganuma Toru, Nakagawa Hiroaki, Takada Toshihiko
Department of General Internal Medicine, Fukushima Medical University, Fukushima, JPN.
Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, JPN.
Cureus. 2023 Oct 29;15(10):e47933. doi: 10.7759/cureus.47933. eCollection 2023 Oct.
Intravenous antibiotics are the primary treatment of choice for pyogenic vertebral osteomyelitis (PVO). Surgical intervention is required when the initial antibiotic treatment fails but is often difficult to perform, especially in older adults with multiple comorbidities, because of the reduced physical activity. The size of the infection signal in the spinal bone on magnetic resonance imaging (MRI) at the time of diagnosis was reported to have a high predictive accuracy for antibiotic treatment failure. However, the sample size was too small for this result to be adopted in clinical practice. Thus, we conducted a validation study of the previous research using a larger sample size.
We conducted a retrospective review of electronic medical records of patients admitted to the orthopedic department of a university hospital with a diagnosis of PVO between 2006 and 2021, and consecutively included patients without planned PVO surgery on admission and with a sagittal view of T1-weighted spinal MRI at the time of diagnosis. The index test was the percentage involvement of the affected areas in one motion segment on sagittal MRI. We also evaluated other MRI findings, such as bone destruction, segmental instability, epidural abscesses, and multiple sites for their predictive accuracy for antibiotic treatment failure.
A total of 82 participants were eligible for the analysis. The presence of ≥90% affected area of one motion segment had a sensitivity of 16.7% and a specificity of 70.3% for future antibiotic treatment failure, resulting in poor predictive performance, with positive (LR+) and negative likelihood ratios of 0.56 and 1.19, respectively. The area under the receiver operating characteristic curve for a 10% increase in the affected area was 0.48. Among the other MRI findings, the presence of bone destruction had a significantly higher predictive accuracy (LR+ 3.11, 95% confidence interval 1.30-7.42).
An infection signal ≥90% on a T1-weighted MRI of one spinal motion segment did not show sufficient predictive performance for antibiotic treatment failure. Spinal bone destruction had a mild-to-moderate predictive accuracy.
静脉注射抗生素是化脓性脊椎骨髓炎（PVO）的主要治疗选择。当初始抗生素治疗失败时需要进行手术干预，但由于身体活动能力下降，手术往往难以实施，尤其是在患有多种合并症的老年人中。据报道，诊断时磁共振成像（MRI）上脊椎骨感染信号的大小对抗生素治疗失败具有较高的预测准确性。然而，样本量太小，无法将这一结果应用于临床实践。因此，我们使用更大的样本量对先前的研究进行了验证性研究。
我们对2006年至2021年期间在某大学医院骨科确诊为PVO的患者的电子病历进行了回顾性分析，连续纳入入院时未计划进行PVO手术且诊断时具有T1加权脊柱MRI矢状面图像的患者。指标测试是矢状面MRI上一个运动节段受累区域的百分比。我们还评估了其他MRI表现，如骨质破坏、节段性不稳定、硬膜外脓肿以及多个部位对抗生素治疗失败的预测准确性。
共有82名参与者符合分析条件。一个运动节段受累面积≥90%对未来抗生素治疗失败的敏感性为16.7%，特异性为70.3%，预测性能较差，阳性（LR+）和阴性似然比分别为0.56和1.19。受累面积增加10%时的受试者工作特征曲线下面积为0.48。在其他MRI表现中，骨质破坏的预测准确性显著更高（LR+ 3.11，95%置信区间1.30 - 7.42）。
一个脊柱运动节段的T1加权MRI上感染信号≥90%对抗生素治疗失败未显示出足够的预测性能。脊椎骨破坏具有轻度至中度的预测准确性。
