vertebral osteomyelitis
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Etiology
- also see spinal infection
- Staphylococcus aureus (most common)
- special populations
Epidemiology
- see spinal infection
Pathology
- see spinal infection
Clinical manifestations
- new onset or worsening back pain or neck pain
- local tenderness
- radicular pain
- motor weakness
- sensory deficits
- fever (50%)
- see spinal infection
Laboratory
Diagnostic procedures
- CT-guided fine needle aspiration/bone biopsy* with cultures if blood cultures negative[4]
* not initial diagnostic test
* disk space aspiration/biopsy if discitis with osteomyelitis involving contiguous vertebral body endplates
* open biopsy if 2 attempts at percutaneous biopsy fail[4]
Radiology
- MRI of the spine with gadolinium contrast (gold standard)*
- CT of spine if MRI is not an option
- see spinal infection
* can also detect spinal epidural abscess
Complications
- also see spinal infection
Differential diagnosis
* surgical decompression after blood cultures & antibiotics & prior to bone biopsy[4]
Management
- 2 weeks of intravenous antibiotics[3]
- oral antibiotics may be acceptable[4]
- empiric therapy pending culture
- fluoroquinolone plus rifampin as oral therapy to complete 6 weeks of therapy[3]*
* antibiotic choice will depend on results of culture & antibiotic sensitivity testing
* duration of antibiotic therapy may need to be longer if complicated by abscess[3]
More general terms
References
- ↑ Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
- ↑ Zimmerli W. Clinical practice. Vertebral osteomyelitis. N Engl J Med. 2010 Mar 18;362(11):1022-9. Review. PMID: https://pubmed.ncbi.nlm.nih.gov/20237348
- ↑ 3.0 3.1 3.2 3.3 Bernard L et al. Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: An open-label, non- inferiority, randomised, controlled trial. Lancet 2014 Nov 5; <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/2546817 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961233-2/fulltext
Lora-Tamayo J and Murillo O. Shorter treatments for vertebral osteomyelitis. Lancet 2014 Nov 5 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/25468169 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961936-X/fulltext - ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ Weissman S, Parker RD, Siddiqui W, Dykema S, Horvath J. Vertebral osteomyelitis: retrospective review of 11 years of experience. Scand J Infect Dis. 2014 Mar;46(3):193-9. Epub 2014 Jan 23. PMID: https://pubmed.ncbi.nlm.nih.gov/24450841
- ↑ Berbari EF, Kanj SS, Kowalski TJ et al 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults. Clin Infect Dis. 2015 Sep 15;61(6):e26-46. Review. PMID: https://pubmed.ncbi.nlm.nih.gov/26229122
Berbari EF, Kanj SS, Kowalski TJ, et al. Executive summary: 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis. 2015;61:859-63. PMID: https://pubmed.ncbi.nlm.nih.gov/26316526