Important laboratory parameters that may be assessed include serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell (WBC) count with differential, and blood cultures [37,48-50]. Other testing such as for brucella or mycobacterium may be helpful if the patient is from the appropriate endemic area [2,4,5,7]. Because the imaging appearance of spine infection may overlap with other noninfectious pathologic entities, such as degenerative disc disease, inflammation, trauma, or neoplasm, spine biopsy with microbiologic and histopathologic analysis of the infected tissue is often required for diagnostic confirmation [35,51-58]. Special Imaging Considerations Although the clinical presentation and physical examination can help localize the level of suspected spine infection, in specific clinical situations it may be beneficial to image the entire spine [21,59]. This may be influenced by clinical presentation and patient factors such as a history of IV drug use, specific pathogens such as tuberculosis, or initial imaging findings that demonstrate multilevel spine involvement [21,59-61]. Like other spine infections, spinal epidural abscess has increased in incidence and is now seen in 2.5 to 3/10,000 patients [3,60]. Epidural abscess is often associated with diagnostic delay that can potentially lead to significant neurologic morbidity and mortality. Patients with preexisting risk factors, such as having a potential source for infection (preexisting infection, IV drug use, recent spine procedure) or a reason for being immunosuppressed (diabetes, steroid use) and patients with an elevated ESR, may be at increased risk for epidural abscess [18,21,22,62].
Suspected Spine Infection PCAs. Important laboratory parameters that may be assessed include serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell (WBC) count with differential, and blood cultures [37,48-50]. Other testing such as for brucella or mycobacterium may be helpful if the patient is from the appropriate endemic area [2,4,5,7]. Because the imaging appearance of spine infection may overlap with other noninfectious pathologic entities, such as degenerative disc disease, inflammation, trauma, or neoplasm, spine biopsy with microbiologic and histopathologic analysis of the infected tissue is often required for diagnostic confirmation [35,51-58]. Special Imaging Considerations Although the clinical presentation and physical examination can help localize the level of suspected spine infection, in specific clinical situations it may be beneficial to image the entire spine [21,59]. This may be influenced by clinical presentation and patient factors such as a history of IV drug use, specific pathogens such as tuberculosis, or initial imaging findings that demonstrate multilevel spine involvement [21,59-61]. Like other spine infections, spinal epidural abscess has increased in incidence and is now seen in 2.5 to 3/10,000 patients [3,60]. Epidural abscess is often associated with diagnostic delay that can potentially lead to significant neurologic morbidity and mortality. Patients with preexisting risk factors, such as having a potential source for infection (preexisting infection, IV drug use, recent spine procedure) or a reason for being immunosuppressed (diabetes, steroid use) and patients with an elevated ESR, may be at increased risk for epidural abscess [18,21,22,62].