Background: Treatment of bacterial diskospondylitis requires an extended course of systemic antibiotics. Local percutaneous installation of antibiotic-infused hydrogel for the treatment of diskospondylitis has not been reported. Hypothesis/
Objectives: Assess the feasibility and safety of ultrasound-guided percutaneous hydrogel injections into the intervertebral disc space for local management of diskospondylitis in dogs. Animals: Four canine cadavers.
Methods: Cadavers were randomly assigned to either group A (T13-L1, L2-L3, L4-L5, L6-L7) or group B (L1-L2, L3-L4, L5-L6, L7-S1). For T13-L1, the cadaver was placed in sternal recumbency and obliqued away from the operator with the spinal needle directed in dorsolateral-to-ventromedial orientation. For L1-L2 through L7-S1, the cadaver was placed in dorsal recumbency with the spinal needle directed ventrally. A 1:4 iodinated contrast to pluronic gel solution was injected into the intervertebral disc space with ultrasound guidance (0.2mL). CT was performed before and after completion of injection series and evaluated for anatomic variation, presence/absence of contrast in the designated intervertebral disc spaces, and presence/location of injection leakage.
Results: A total of 16 injections were performed. Injection into the intervertebral disc space was successful in 11 injections (68.8%). Leakage outside of the intervertebral disc space was present in 9 injections (56.3%; paravertebral n=8, intraparenchymal n=1). Injection resistance (n=6) and visibility (n=4) were noted challenges. Conclusions and Clinical Importance: Percutaneous ultrasound-guided hydrogel injections into the intervertebral disc space as a novel local therapy for diskospondylitis is feasible. Leakage was present in over half of all injections, however, considered clinically significant and potentially catastrophic in only one injection.
