Neurospine.  2019 Dec;16(4):756-763. 10.14245/ns.1836296.148.

High Prevalence of Multifocal Spine Infections Involving the Cervical and Thoracic Regions: A Case for Imaging the Entire Spine

• Balcescu C
• Odeh K
• Rosinski A
• Wang J
• Prasad P
• Leasure J
• Ungurean V
• Kondrashov D

• KMID: 2469053
• DOI: http://doi.org/10.14245/ns.1836296.148

Abstract

OBJECTIVE
Pyogenic spinal infections account for 2%-4% of orthopaedic infections. They are often difficult to diagnose, resulting in a delay in diagnosis. Risk factors for orthopaedic and spinal infection are well-documented in the literature, yet there is a paucity of studies examining risk factors specifically for multifocal spinal infections. The objective of this study was to identify predictors of multifocal spinal infections in comparison to unifocal spinal infections.
METHODS
The medical records, imaging studies, and bacteriology data of 20 patients treated surgically for pyogenic spinal infection over 6 years at a tertiary referral center were reviewed and analyzed after receiving Institutional Review Board approval. Univariate and multivariate analyses were performed to identify factors associated with a multifocal spinal infection.
RESULTS
Seven patients (35%) had multifocal infections. Three were bifocal, and 4 were trifocal. Patients with surgically treated cervical or thoracic spinal infections had a high rate of concomitant multifocal spinal infections (71% and 83%, respectively). Other potential predictors (e.g., patient age, body mass index, magnetic resonance image findings, etc.) did not reach statistical significance. Each of the multifocal infections involved the lumbar spine.
CONCLUSION
In this study, the spinal region was the only statistically significant risk factor for multifocal infection. Patients who are diagnosed with a spinal infection that requires operative treatment should have their entire spine evaluated with magnetic resonance imaging to detect multifocal involvement promptly.

Keyword

Spinal infection; Multifocal infection; Unifocal infection; Abscess; Osteomyelitis

MeSH Terms

Abscess
Bacteriology
Body Mass Index
Diagnosis
Ethics Committees, Research
Humans
Magnetic Resonance Imaging
Medical Records
Multivariate Analysis
Osteomyelitis
Prevalence*
Risk Factors
Spine*
Tertiary Care Centers