Abstract
Purpose
To retrospectively describe the feasibility and efficacy of CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction with a combination of two interventional radiological techniques—CT-guided bone biopsy and abscess drainage.
Materials and methods
Three patients with pyogenic spondylodiscitis at the lumbosacral junction were enrolled in this study between July 2013 and December 2015. The procedure of CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction was as follows: the sacrum at S1 pedicle was penetrated with an 11-gauge (G) bone biopsy needle to create a path for an 8-French (F) pigtail drainage catheter. The bone biopsy needle was withdrawn, and an 18-G needle was inserted into the intervertebral space of the lumbosacral junction. Then, a 0.038-inch guidewire was inserted into the intervertebral space. Finally, the 8-F pigtail drainage catheter was inserted over the guidewire until its tip reached the intervertebral space. All patients received six-week antibiotics treatment.
Results
Successful placement of the drainage catheter was achieved for each patient without procedural complications. The duration of drainage was 17–33 days. For two patients, specific organisms were isolated; thus, definitive medical therapy was possible. All patients responded well to the treatment.
Conclusions
CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction is feasible and can be effective with a combination of two interventional techniques—CT fluoroscopy-guided bone biopsy and abscess drainage.
References
Acosta FL Jr, Galvez LF, Aryan HE, Ames CP. Recent advances: infections of the spine. Curr Infect Dis Rep. 2006;8(5):390–3.
Grados F, Lescure FX, Senneville E, Flipo RM, Schmit JL, Fardellone P. Suggestions for managing pyogenic (non-tuberculous) discitis in adults. Jt Bone Spine. 2007;74(2):133–9.
Staatz G, Adam GB, Keulers P, Vorwerk D, Gunther RW. Spondylodiskitic abscesses: CT-guided percutaneous catheter drainage. Radiology. 1998;208(2):363–7.
Matsumoto T, Yamagami T, Morishita H, Iida S, Asai S, Masui K, et al. CT-guided percutaneous drainage within intervertebral space for pyogenic spondylodiscitis with psoas abscess. Acta Radiol. 2012;53(1):76–80.
Griffiths HE, Jones DM. Pyogenic infection of the spine. A review of twenty-eight cases. J Bone Jt Surg Br. 1971;53(3):383–91.
Tofuku K, Koga H, Komiya S. Percutaneous drainage combined with hyperbaric oxygen therapy for pyogenic spondylitis with iliopsoas abscess. Asian Spine J. 2014;8(3):253–9.
Daly B, Templeton PA. Real-time CT fluoroscopy: evolution of an interventional tool. Radiology. 1999;211(2):309–15.
Kato T, Yamagami T, Iida S, Tanaka O, Hirota T, Nishimura T. Percutaneous drainage under real-time computed tomography-fluoroscopy guidance. Hepatogastroenterology. 2005;52(64):1048–52.
Yamagami T, Terayama K, Yoshimatsu R, Matsumoto T, Miura H, Nishimura T. Percutaneous drainage of psoas abscess under real-time computed tomography fluoroscopic guidance. Skelet Radiol. 2009;38(3):275–80.
Jeanneret B, Magerl F. Treatment of osteomyelitis of the spine using percutaneous suction/irrigation and percutaneous external spinal fixation. J Spinal Disord. 1994;7(3):185–205.
Gervais DA, Brown SD, Connolly SA, Brec SL, Harisinghani MG, Mueller PR. Percutaneous imaging-guided abdominal and pelvic abscess drainage in children. Radiographics. 2004;24(3):737–54.
McHenry MC, Easley KA, Locker GA. Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis. 2002;34(10):1342–50.
Acknowledgments
We would like to thank Prof. Tetsuya Suzuki, Prof. Atsushi Hotta, and their students of the Department of Mechanical Engineering, Keio University, for their help in the creation of some of the figures; Dr. Yusuke Kabeya and Dr. Eiseki Sohara of the Department of General Internal Medicine, Tokai University Hachioji Hospital, for their help in patient management; and Dr. Kazunobu Hashida, Dr. Kosuke Tomita, and Dr. Satoshi Suda of the Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, for continuing support and encouragement.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Tomohiro Matsumoto and Terumitsu Hasebe contributed equally to this work.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary material 1 (WMV 1537 kb)
Rights and permissions
About this article
Cite this article
Matsumoto, T., Mine, T., Hayashi, T. et al. CT Fluoroscopy-Guided Transsacral Intervertebral Drainage for Pyogenic Spondylodiscitis at the Lumbosacral Junction. Cardiovasc Intervent Radiol 40, 125–129 (2017). https://doi.org/10.1007/s00270-016-1452-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-016-1452-9