CT guided biopsy in spondylodiskitis

Objective: To analyze the results of needle biopsies guided by computerized tomography (CT), in vertebral disk infections. Material and Methods: From 22-06-90 to 31-12-98, 582 CT-guided aspiration biopsies were performed in 558 patients at the Hospital Privado del Sur. Biopsies were performed due to spondilodiskitis in 34 patients (6,08%); 22 were male and 12 were female. Ages ranged from 15 months to 89 years. Bacilloscopy and cultures for usual microorganisms as well as anaerobes, plus antibiogram (in case of bacterial growth) were performed in all patients. Pathology was analyzed in 31/34 biopsies. In 3 patients, no pathology was requested (2 were post-operative spondiloskitis due to disk hernias and in a third patient the material obtained was insufficient and was reserved for bacteriological analysis). Results: The levels involved were spaces: C7-D1 and D7-D8: 1 patient in each one (n=2); D8-D9, D9-D10; D12-L1 and L5-S1: 2 (n=8); L1-L2: n=3; L2-L3: n=5 (with 6 biopsies); L3-L4: n=5 and L4-L5: n=11. Bacteriology was positive in 18 patients (53%). When cultures were negative (16 patients), pathology showed potential infectious origin in 11; in 4 the results were 'not conclusive' (non specific) and the remaining patient was not evaluated due to technical difficulties, but did well with antibiotic treatment. The only complication was a limited hematoma in the dorsal muscles due to puncture of a thoracic fibrocartilage. Conclusion: Aspiration biopsy under CT guidance is a fast, safe and effective method for the diagnosis of spondiylodiskitis. It enables isolation of the microorganism in half of the cases, and with the aid of pathology, the presence of an infectious disease may be established thus allowing the rapid empiric antibiotic treatment in more than 68% (11/16 patients) who do not have positive cultures. (author)