Vertebral osteomyelitis
(also termed spinal osteomyelitis, spondylodiskitis, or disk-space infection), is a type of osteomyelitis (which is infection and inflammation of the bone and bone marrow).
Spinal epidural abscess (SEA) is often associated with vertebral osteomyelitis (in one series of 40 cases, osteomyelitis occurred in all cases of anterior SEA, in 85% of circumferential SEA, and no cases of posterior SEA) and intervertebral discitis.
Organisms
1. Staphylococcus aureus is the most common pathogen (> 50%) as in SEA
2. E. coli is a distant second
3. organisms associated with some primary infection sites:
a) IVdrugabusers:Pseudomonas aeruginosa and S.aureus are common
b) urinary tract infections:E.coli & Proteus spp.are common
c) respiratory tract infections: Streptococcus pneumoniae
d) alcohol abuse: Klebsiella pneumoniae
e) endocarditis:
● acute endocarditis: Staph. aureus
● subacute endocarditis: Streptococcus spp.
4. tuberculous VO: Mycobacterium tuberculosis
5. unusual organisms include: nocardia
6. Mycobacterium avium complex (M. Avium and M. intracellulare) (MAC) can cause pulmonary disease in nonimmunocompromised patients (usually elderly or on chronic steroids), but can also cause VO similar to TB as part of disseminated disease which usually occurs in HIV patients
7. polymicrobial infections: rare (< 2.5% of pyogenic VO infections)
Classification
It is divided into three categories according to the causative microorganism, namely pyogenic, tuberculous, and brucellar 1)
see Pyogenic vertebral osteomyelitis.
see Tuberculous vertebral osteomyelitis.
see Spinal Brucellosis.
Vertebral osteomyelitis is a rare bone infection concentrated in the spinal region.
Cases of vertebral osteomyelitis are so rare that only 2-4% of all bone infections are attributed to the disease.
The infection can be classified as acute or chronic depending on the severity of the onset of the case, where acute patients often experience better outcomes than those living with the chronic symptoms that are characteristic of the disease. Although vertebral osteomyelitis is found in patients across a wide range of ages, the infection is commonly reported in young children and older adults. Vertebral osteomyelitis often attacks two vertebrae and the corresponding intervertebral disk, causing narrowing of the disc space between the vertebrae.
The prognosis for the disease is dependent on where the infection is concentrated in the spine, the time between initial onset and treatment, and what approach is used to treat the disease.
Diagnosis
Complications
Treatment
Case series
From 1980 to 1990, 309 cases of haematogenous osteomyelitis were identified in Denmark. Haematogenous osteomyelitis of the vertebral column increased significantly (P < 0.01) from the first to the second half of the period due to an increased number of patients > 50 years of age with community-acquired infection. Vertebral osteomyelitis differed significantly from osteomyelitis of other bones in accordance to age distribution (median 66 vs. 16 years), male/female ratio (75/71 vs. 105/ 58) and patients with diabetes (13% vs. 6%).
Jensen et al., found a higher risk of haematogenous osteomyelitis in patients > 50 years of age and among patients with community-acquired infection. The highest incidence (5%) of vertebral osteomyelitis in Staphylococcus aureus bacteraemia in this age group was found in cases without an identified portal of entry. The highest incidence (34%) of osteomyelitis of other bones was found in community-acquired cases in the age group 1-20 years and without an identified portal of entry. The present study discusses reasons for the continued increase of vertebral osteomyelitis among adults and describes incidence rates and major risk factors for developing haematogenous osteomyelitis among patients with S. aureus bacteraemia. They suggest that the localization of haematogenous S. aureus osteomyelitis is connected with the presence of red bone marrow 2).
Case reports
Dornbos et al., report a rare case of multifocal thoracic osteomyelitis with an epidural abscess in a patient with a biopsy-proven pathogen of cat scratch disease. A 5-year-old girl, who initially presented with vague constitutional symptoms, was diagnosed with cat scratch disease following biopsy of an inguinal lymph node. Despite appropriate antibiotics, she presented several weeks later with recurrent symptoms and back pain. Magnetic resonance imaging revealed 2 foci of osteomyelitis at T-8 and T-11 with an associated anterior epidural abscess from T-9 to T-12. Percutaneous image-guided vertebral biopsy revealed B. henselae by polymerase chain reaction analysis, and she was treated conservatively with doxycycline and rifampin with favorable clinical outcome 3).