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CT Fluoroscopy-Guided Transsacral Intervertebral Drainage for Pyogenic Spondylodiscitis at the Lumbosacral Junction

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 The bone biopsy needle was withdrawn, and an 18-G needle was inserted into the intervertebral space of the lumbosacral junction.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.

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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

Correspondence to Terumitsu Hasebe.

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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.

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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) doi:10.1007/s00270-016-1452-9

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Keywords

  • CT fluoroscopy-guided drainage
  • Pyogenic spondylodiscitis
  • Interventional radiology
  • Lumbosacral junction