A simple needle disc puncture in the cervical spine is a safe and efficient alternative to disc/vertebral biopsy: ten years' experience in a reference centre.

Abstract

Disc/vertebral infection (DVI) often requires invasive sampling for microbiological diagnosis when blood cultures are negative. CT-guided disc/vertebral biopsy is the standard diagnostic procedure but is technically challenging and associated with neurological risks in the cervical region. The technique requires sedation or general anaesthesia. These factors may cause organizational complexity, longer processing times and further delay treatment. This study assesses the diagnostic value of simple CT-guided fine-needle disc puncture (CTFNP) under local anaesthesia as an alternative in suspected cervical DVI. This retrospective study included patients managed for DVI between 2015 and 2025 at a single referral centre. All patients underwent CTFNP under local anaesthesia for suspected cervical DVI after a recent MRI and without prior empiric antibiotic therapy. Culture positivity was assessed for each case. Data were collected and correlated with microbiological findings. Ten patients were included. Microbiological cultures were positive in nine of ten cases. Five patients had a history of head and neck cancer or neck irradiation. In this subgroup, the bacteria predominantly originated from the otolaryngological (ENT) region and mainly belonged to the Streptococcus anginosus group (n = 5). Intradiscal fluid on MRI was reported in only three cases. Sample volumes were small. The mean procedure time was 20 minutes and the median interval between the referring physician's request and CTFNP was 1.5 days. No major complications were reported. Fine-needle disc puncture may be an effective, rapid and low risk alternative to the standard technique in patients with disc vertebral infection in the cervical spine.