title: Histological analysis of surgical samples and a proposed scoring system for infections in intervertebral discs.
abstract: Back pain remains one the most prevalent types of pain and disability worldwide. Infection is estimated to be the underlying cause in approximately 0.01% of patients. Despite recent evidence demonstrating prominent infection rates, a standardised algorithm for diagnosis of disc infection is lacking. Histopathological evaluation can aid in confirming inflammatory changes and also in identifying degenerative changes. Hence, standardising practice through a clear scoring system with regards to inflammation and degeneration may have some utility in the clinical setting. To our knowledge no such systems exist specifically for intervertebral disc infection. A literature review of current methods of scoring inflammation and degeneration in spine surgery and orthopaedic surgery was performed. Based on the current evidence, a scoring system for disc inflammatory and degenerative changes was proposed. We propose four domains for consideration: (1) granulation tissue, (2) dense fibrosis, (3) chronic inflammatory cells, and (4) neutrophil count. The non-standardised nature of diagnosing infections and degeneration in the spinal surgery literature means that this scoring system is currently of particular value. Based on a literature review, our proposed method for diagnosis incorporates a combination of histopathological criteria expected to increase diagnostic sensitivity in the setting of disc infection. Overall, scoring can be applied to surgically obtained material and integrated directly into routine pathological practice.
authors.affiliation: NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Suite 7, Level 7, Randwick, Sydney, NSW 2031, Australia; University of New South Wales, Sydney, NSW, Australia. Electronic address: prashanthdr@gmail.com.
authors.forename: Prashanth J
authors.initials: PJ
authors.lastname: Rao
authors.affiliation: NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Suite 7, Level 7, Randwick, Sydney, NSW 2031, Australia; University of New South Wales, Sydney, NSW, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
authors.affiliation: NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Suite 7, Level 7, Randwick, Sydney, NSW 2031, Australia; University of New South Wales, Sydney, NSW, Australia.
authors.forename: Monish M
authors.initials: MM
authors.lastname: Maharaj
authors.affiliation: NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Suite 7, Level 7, Randwick, Sydney, NSW 2031, Australia.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Scherman
authors.affiliation: Department of Pathology, Prince of Wales Hospital, Sydney, NSW, Australia.
authors.forename: Neil
authors.initials: N
authors.lastname: Lambie
authors.affiliation: Department of Pathology, Prince of Wales Hospital, Sydney, NSW, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Salisbury
authors.affiliation: NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Suite 7, Level 7, Randwick, Sydney, NSW 2031, Australia; University of New South Wales, Sydney, NSW, Australia.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Mobbs
mesh_terms: D003141:Communicable Diseases / Q000175:diagnosis*; D006801:Humans; D007249:Inflammation / Q000175:diagnosis*; D007403:Intervertebral Disc / Q000473:pathology*; D017410:Practice Guidelines as Topic; D013122:Spinal Diseases / Q000175:diagnosis*
keywords: Histopathology; Infections; Intervertebral disc; Scoring system