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Is There an Association Between Magnetic Resonance Imaging and Neurological Signs in Patients With Vertebral Osteomyelitis?

View Article: PubMed Central - PubMed

ABSTRACT

Neurological complications can occur in up to 51% of vertebral osteomyelitis (VO) in surgical series. The aim of our study was to estimate the frequency of neurological signs in a nonselected population of patients with VO and to assess clinical and MRI changes associated with these complications.

We reviewed medical charts of patients with VO from 2007 to 2014 in our University Hospital and their MRIs were analyzed by a radiologist blinded from clinical data. Neurological status was defined as follow: normal, minor signs (radiculalgia or sensory loss), and major signs (motor deficit and/or sphincter dysfunction).

A total of 121 patients were included. Mean age was 64.3 years. Overall, 50 patients (40%) had neurological signs, 26 were major signs (21.5%). Neurological signs were present at the time of admission in 37 patients and happened secondarily in 13 cases. MRI changes associated with major neurological signs were: Cervical involvement (P = 0.011), dural sac compression (P = 0.0012), ventral effacement of the subarachnoidal space (P < 0.001), compressive myelopathy (P = 0.006). More than 50% of the vertebral body destruction (P = 0.017), angular kyphosis (P = 0.016) partial or complete destruction of posterior arch (P = 0.032) were also associated with these signs. Neither epidural abscesses, multifocal lesions, loss of disk height, nor nerve roots compression were associated with major neurological signs.

Neurological signs occurred in 40% of our patients with one half being major signs. Cervical involvement, vertebral destruction, angular kyphosis, dural compression, effacement of subarachnoid space and compressive myelopathy on MRI were risk factors associated with neurological complications.

No MeSH data available.


Related in: MedlinePlus

Examples of MRI abnormality: Epidural abscess in T1 weighted sagittal plane with fat saturation and gadolinium enhancement and compression of the dural sac (A), compressive myelopathy with spinal cord hypersignal (arrow) and anterior effacement of subarachnoid space in T2 weighted sagittal plane (B), edema and destruction of the posterior arch in T2 weighted sagittal plane with fat-saturation (C), voluminous epidural abscess with stenosis and anterior effacement of subarachnoid space in T2 weighted sagittal plane (D).
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Figure 1: Examples of MRI abnormality: Epidural abscess in T1 weighted sagittal plane with fat saturation and gadolinium enhancement and compression of the dural sac (A), compressive myelopathy with spinal cord hypersignal (arrow) and anterior effacement of subarachnoid space in T2 weighted sagittal plane (B), edema and destruction of the posterior arch in T2 weighted sagittal plane with fat-saturation (C), voluminous epidural abscess with stenosis and anterior effacement of subarachnoid space in T2 weighted sagittal plane (D).

Mentions: An independent radiologist, expert in musculoskeletal imaging, reviewed blindly all MRI acquisitions and fulfilled a standardized questioner. This questioner had been previously validated by radiologists, expert spine neurosurgeons, and rheumatologists (Figure 1).


Is There an Association Between Magnetic Resonance Imaging and Neurological Signs in Patients With Vertebral Osteomyelitis?
Examples of MRI abnormality: Epidural abscess in T1 weighted sagittal plane with fat saturation and gadolinium enhancement and compression of the dural sac (A), compressive myelopathy with spinal cord hypersignal (arrow) and anterior effacement of subarachnoid space in T2 weighted sagittal plane (B), edema and destruction of the posterior arch in T2 weighted sagittal plane with fat-saturation (C), voluminous epidural abscess with stenosis and anterior effacement of subarachnoid space in T2 weighted sagittal plane (D).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998243&req=5

Figure 1: Examples of MRI abnormality: Epidural abscess in T1 weighted sagittal plane with fat saturation and gadolinium enhancement and compression of the dural sac (A), compressive myelopathy with spinal cord hypersignal (arrow) and anterior effacement of subarachnoid space in T2 weighted sagittal plane (B), edema and destruction of the posterior arch in T2 weighted sagittal plane with fat-saturation (C), voluminous epidural abscess with stenosis and anterior effacement of subarachnoid space in T2 weighted sagittal plane (D).
Mentions: An independent radiologist, expert in musculoskeletal imaging, reviewed blindly all MRI acquisitions and fulfilled a standardized questioner. This questioner had been previously validated by radiologists, expert spine neurosurgeons, and rheumatologists (Figure 1).

View Article: PubMed Central - PubMed

ABSTRACT

Neurological complications can occur in up to 51% of vertebral osteomyelitis (VO) in surgical series. The aim of our study was to estimate the frequency of neurological signs in a nonselected population of patients with VO and to assess clinical and MRI changes associated with these complications.

We reviewed medical charts of patients with VO from 2007 to 2014 in our University Hospital and their MRIs were analyzed by a radiologist blinded from clinical data. Neurological status was defined as follow: normal, minor signs (radiculalgia or sensory loss), and major signs (motor deficit and/or sphincter dysfunction).

A total of 121 patients were included. Mean age was 64.3 years. Overall, 50 patients (40%) had neurological signs, 26 were major signs (21.5%). Neurological signs were present at the time of admission in 37 patients and happened secondarily in 13 cases. MRI changes associated with major neurological signs were: Cervical involvement (P = 0.011), dural sac compression (P = 0.0012), ventral effacement of the subarachnoidal space (P < 0.001), compressive myelopathy (P = 0.006). More than 50% of the vertebral body destruction (P = 0.017), angular kyphosis (P = 0.016) partial or complete destruction of posterior arch (P = 0.032) were also associated with these signs. Neither epidural abscesses, multifocal lesions, loss of disk height, nor nerve roots compression were associated with major neurological signs.

Neurological signs occurred in 40% of our patients with one half being major signs. Cervical involvement, vertebral destruction, angular kyphosis, dural compression, effacement of subarachnoid space and compressive myelopathy on MRI were risk factors associated with neurological complications.

No MeSH data available.


Related in: MedlinePlus