OrthoNet

Vertebral Osteomyelitis

- via hematogenous spread, contiguous spread or direct contamination
- risk factors = DM, extremes of age, IVDU, immunocompromised status (HIV, steroids)
- remember to look for source of infection (eg. skin lesions, UTI, etc)
- organisms = S. aureus (most common)
- classification: acute = 3 mos of symptoms
- pathophysiology - infection spread thru end arteriole anastomoses within metaphyseal region of vertebral body à spreads across disc space

SSx:
- presents with pain, muscle spasm & possibly neurology
- fever (50%)
- neurological deficit including radiculopathy, myelopathy, complete paralysis

Labs:
- elevated ESR & CRP with normal CBC in 50%
- blood cultures (+ve in 50%)

Investigations:
- xrays - may not see changes in 1st 2-4 wks of infection
- CT scan with sagittal reformats to delineate bony destruction/sequestrum
- MRI to assess cord compression & presence of epidural abscess
- biopsy to obtain tissue for culture & sensitivity - may be closed or open technique

Treatment:
** do not treat with empiric ABx in adults **
- need to assess stability (White & Panjabi in cervical spine)- may require surgical intervention because of instability
- need to assess neurology à significant or worsening neuro deficit is an indication for surgery
- IV ABx x 6 wks; cervical or lumbar orthosis, close observation if treating conservatively
- indications for surgery: progressive neuro deficit
significant neuro deficit
instability
epidural abscess
failure of medical therapy alone
- surgery- I & D, tissue culture, anterior decompression +/- stabilization
- should have referral to spine surgeon & infectious diseases