Computed Tomography and Magnetic Resonance Imaging Parameters Associated with Poor Clinical Outcome in Spondylodiscitis

Sarah C Foreman, Benedikt J Schwaiger, Bernhard Meyer, Alexandra S Gersing, Claus Zimmer, Jens Gempt, Jan S Kirschke
World Neurosurgery 2017, 104: 919-926.e2

BACKGROUND: Prognostic factors for the disease course of patients with spondylodiscitis have not been well studied.

METHODS: The prognostic value of initial magnetic resonance imaging (MRI) and computed tomography imaging parameters was analyzed in 62 patients (47% women; mean age ± SD, 71.6 ± 9.6 years) with a confirmed diagnosis of spondylodiscitis. The disease course was separately evaluated during initial treatment response during hospitalization, relapse, and clinical short-term follow-up at 3 months.

RESULTS: Overall CT findings graded as definitely inflammatory (P = 0.006), reduced disc height on MRI (P = 0.044) and fluid-equivalent hyperintensity of discs on T2 short tau inversion recovery-weighted sequences (P = 0.047) were associated with poor initial treatment response. High initial C-reactive protein value (>10.1 mg/dL) was associated with a higher relapse rate (P = 0.038). Risk factors for poor outcome were infection with low-virulence bacteria (P = 0.040) and overall MRI findings atypical for infection (P = 0.027).

CONCLUSIONS: Compared with MRI, CT imaging parameters have a higher prognostic value regarding the disease course. Patients infected with low-virulence bacteria and atypical MRI findings are at higher risk for poor clinical outcome and thus warrant closer monitoring.

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