Vertebral Osteomyelitis

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