The Efficacy of Computed Tomography-Guided Percutaneous Spine Biopsies in Determining a Causative Organism in Cases of Suspected Infection: A Systematic Review

Abstract Purpose In suspected spondylodiscitisand vertebral osteomyelitis, computed tomography (CT)-guided biopsiesare often performed to determine a causative organism and guide antimicrobial therapy. The aim of this study is to determine the diagnostic culture yield of CT-guided biopsiesperformed in cases of suspectedspinal infections. Methods A literature search of PubMed and MEDLINE up to April 2017 was performed for keywords "CT guided vertebral biopsyinfection," "CT-guided spine biopsyinfection," "CT guided spine biopsyyield," and "CT guided vertebral biopsyyield." Inclusion criteria primarily consisted of studies exclusively using CT-guided biopsiesin cases of suspectedinfectious lesions only. After study selection, published articles were analysed to determine diagnostic culture yield. Descriptive statistics were applied. Results 220 search results were screened; 11 met our inclusion criteria and were reviewed. In total, 647 biopsiesof suspectedinfectious spinal lesions were performed. Positive cultures were obtained in 241 cases. Upon excluding one paper's skewed results, the net pooled results culture yield was 33%. Several cultures grew multiple organisms, leading to a total of 244 species identified. Most common isolated organisms include S taphylococcus aureus (n = 83), coagulase-negative S taphylococcus (n = 45), and Mycobacteria (n = 38). Conclusions The diagnostic culture yield of CT-guided biopsiesin cases of suspectedspinal infection is 33%. In the majority of cases, a causative organism is not identified. This suggests that improvements can be made in biopsytechnique and specimen transfer to optimize culture yield and increase the clinical value of the procedure.