Prompt regression of paravertebral and epidural abscesses in patients with pyogenic discitis. Sixteen cases evaluated using magnetic resonance imaging.
OBJECTIVE
To determine whether spinal magnetic resonance imaging performed one month into anti-microbial therapy for pyogenic discitis demonstrated changes of value for predicting outcomes and making therapeutic decisions.


METHODS
Prospective study of 16 patients with discitis. A physical evaluation, laboratory tests for inflammation, plain radiographs centered on the affected vertebral level, and magnetic resonance imaging with gadolinium injection were performed at baseline and on day 30. All 16 patients were reevaluated after three months and 15 after six months.


RESULTS
The 12 men and four women had a mean age of 59 years. Fourteen patients had a paravertebral abscess (n=12) and/or an epidural abscess (n=6). On day 30, 14 of the 16 patients were clinically improved and ten were radiologically improved. The C-reactive protein level was still elevated in five cases. All reevaluated patients were improved after three months (16/16) and six months (15/15). Only two magnetic resonance imaging features improved during the first month: the size of paravertebral abscesses decreased in 11 of 12 patients, and the size of epidural abscesses decreased in four of six patients.


CONCLUSIONS
Paravertebral and epidural abscesses improve promptly under antimicrobial therapy. However, the presence of these lesions have no prognostic significance. Magnetic resonance imaging does not add significantly to the follow-up of patients who respond clinically to antimicrobial therapy. However, in patients with an unsatisfactory clinical response, follow-up magnetic resonance imaging can provide useful therapeutic orientation by showing whether the paravertebral and/or epidural abscesses have decreased in size.
Veillard
E
E
Service de rhumatologie, hôpital Sud, Rennes.
Guggenbuhl
P
P
Morcet
N
N
Meadeb
J
J
Bello
S
S
Perdriger
A
A
Chalès
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015299:Discitis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology*; D018450:Disease Progression; D020802:Epidural Abscess / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome