OR Discussion of Procedures by Variant Variant 1: Suspected spine infection (such as epidural abscess or discitis osteomyelitis), with new or worsening back or neck pain, with or without fever, who may have one or more of the following red flags (diabetes mellitus, IV drug use, cancer, HIV, or dialysis) or abnormal lab values. Initial imaging. The annual incidence of spine infection ranges from 4 to 24 per million per year [10]. In the presence of red flag conditions (diabetes mellitus, IV drug use, cancer, HIV, or dialysis) or abnormal lab values, imaging may be indicated if there is a clinical suspicion for spine infection in a patient with neck or back pain with or without fever. Clinically, it may be difficult to differentiate spine infection from other causes of neck or back pain such as degenerative disease, trauma, inflammatory spondyloarthropathy, or neoplastic involvement of the spine [3,35,55]. As any one of these clinical entities has the potential to mimic the imaging appearance of spine infection, it is important to use the combination of clinical presentation, laboratory values such as an elevated ESR and CRP and imaging findings in order to consider the diagnosis of spine infection [8]. The body regions covered in this clinical scenario are the cervical, thoracic, and lumbar spine. These body regions might be evaluated separately or in combination as guided by physical examination findings, patient history, and other available information. CT Spine Area of Interest As a result of its excellent delineation of osseous detail and greater sensitivity than radiography, CT can be used in the evaluation of spine infection [3]. The addition of IV contrast increases the conspicuity of paraspinal soft tissue abnormalities, such as inflammation or abscess that may be caused by infection.
Suspected Spine Infection PCAs. OR Discussion of Procedures by Variant Variant 1: Suspected spine infection (such as epidural abscess or discitis osteomyelitis), with new or worsening back or neck pain, with or without fever, who may have one or more of the following red flags (diabetes mellitus, IV drug use, cancer, HIV, or dialysis) or abnormal lab values. Initial imaging. The annual incidence of spine infection ranges from 4 to 24 per million per year [10]. In the presence of red flag conditions (diabetes mellitus, IV drug use, cancer, HIV, or dialysis) or abnormal lab values, imaging may be indicated if there is a clinical suspicion for spine infection in a patient with neck or back pain with or without fever. Clinically, it may be difficult to differentiate spine infection from other causes of neck or back pain such as degenerative disease, trauma, inflammatory spondyloarthropathy, or neoplastic involvement of the spine [3,35,55]. As any one of these clinical entities has the potential to mimic the imaging appearance of spine infection, it is important to use the combination of clinical presentation, laboratory values such as an elevated ESR and CRP and imaging findings in order to consider the diagnosis of spine infection [8]. The body regions covered in this clinical scenario are the cervical, thoracic, and lumbar spine. These body regions might be evaluated separately or in combination as guided by physical examination findings, patient history, and other available information. CT Spine Area of Interest As a result of its excellent delineation of osseous detail and greater sensitivity than radiography, CT can be used in the evaluation of spine infection [3]. The addition of IV contrast increases the conspicuity of paraspinal soft tissue abnormalities, such as inflammation or abscess that may be caused by infection.