Vertebral osteomyelitis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

The term osteomyelitis describes any new infection in the bone and bone marrow. Vertebral osteomyelitis is a specific type of disease which describes a rare bone infection concentrated in the spinal region.^[1]

The infection can be classified as acute or chronic depending on the severity of the onset of the case,^[2] where acute patients often experience better outcomes than those living with the chronic symptoms that are characteristic of the disease.

Vertebral osteomyelitis often attacks two vertebrae and the corresponding intervertebral disk, causing narrowing of the disc space between the vertebrae.^[3] A notable aspect of the disease is found in its ability to start anywhere in the body and spread to other regions through the bloodstream. A number of bacterial strains can enter the body in this manner, making the origin of the infection hard to trace; thus, for many patients with the infection, this characteristic can delay an accurate diagnosis and prolong suffering.

Diagnosis can also be complicated due to the disease’s similarity to discitis, commonly known as an infection of the disc space. Both diseases are characterized by a patient’s inability to walk and concentrated back pain; however, patients with vertebral osteomyelitis often appear more ill than those with discitis.^[4] Additional measures may be called upon to rule out the possibility of discitis; such approaches include diagnosing the disease through various medical imaging techniques.

Radiological intervention is often necessary to confirm the presence of vertebral osteomyelitis in the body. Plain-film radiological orders are necessary for all patients displaying symptoms of the disease. This diagnostic approach is often preliminary to other radiological procedures, such as magnetic resonance imaging, or MRI, computed tomography (CT) scan, fine-needle aspiration biopsy, and nuclear scintigraphy. The initial plain-film X-ray images are scanned for any indication of disc compression between two vertebrae or the degeneration of one or more vertebrae. Only when these findings are ambiguous is further testing necessary to diagnose the disease. Other radiological approaches offer more comprehensive imaging of the spinal area, but can often prove inconclusive.

If MRI imaging is inconclusive, the high sensitivity to erosions in the vertebrae or intervertebral discs of CT scans may be preferred for their ability to indicate signs of the disease more clearly than MRI.

MRI scans do not expose the patient to radiation and are highly sensitive to changes in the size and appearance of the intervertebral discs; however, findings on the MRI scan may be confused with other conditions such as the presence of tumors or bone fractures.

Additional tests may be ordered if such preliminary tests cannot confirm a diagnosis; for example, nuclear bone scans may be used to contrast areas of healthy bone with areas of infection.

Additional tests may be ordered if such preliminary tests cannot confirm a diagnosis; for example, needle biopsies may be needed to take samples of bone surrounding the disc space where the infection is thought to live.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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The infection can be classified as acute or chronic depending on the severity of the onset of the case,^[1] where acute patients often experience better outcomes than those living with the chronic symptoms that are characteristic of the disease.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Vertebral osteomyelitis often attacks two vertebrae and the corresponding intervertebral disk, causing narrowing of the disc space between the vertebrae.^[1] A notable aspect of the disease is found in its ability to start anywhere in the body and spread to other regions through the bloodstream. A number of bacterial strains can enter the body in this manner, making the origin of the infection hard to trace; thus, for many patients with the infection, this characteristic can delay an accurate diagnosis and prolong suffering.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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The most common microorganism associated with vertebral osteomyelitis is the bacteria staphylococcus aureus. Another strain of staphylococcus aureus, commonly known as methicillin-resistant staphylococcus aureus (MRSA), is a particularly harmful microorganism that is more difficult to treat than other related strains. Streptococcus equisimilis may also be responsible for the onset of vertebral osteomyelitis, though it is thought to be less virulent than staphylococcus aureus.^[1]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Diagnosis can also be complicated due to the disease’s similarity to discitis, commonly known as an infection of the disc space. Both diseases are characterized by a patient’s inability to walk and concentrated back pain; however, patients with vertebral osteomyelitis often appear more ill than those with discitis.^[1] Additional measures may be called upon to rule out the possibility of discitis; such approaches include diagnosing the disease through various medical imaging techniques.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Cases of vertebral osteomyelitis are so rare that only 2-4% of all bone infections are attributed to the disease.^[1]

Although vertebral osteomyelitis is found in patients across a wide range of ages, the infection is commonly reported in young children and older adults.

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• 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.
• Mortality rates are noted to be higher in patients whose infection is due to the bacteria, staphylococcus aureus. However, if diagnosed quickly and treated correctly, patients with staphylococcus aureus experience better outcomes than those with the disease caused by other microorganisms.
• The subtle progression of vertebral osteomyelitis places patients at risk for paralysis, especially if the infection is concentrated in the thoracic or cervical vertebrae.
• Research published in The Journal of Bone and Joint Surgery (1997) notes that most patients do not experience symptoms of the infection following surgical intervention; therefore, patients with an advanced case of vertebral osteomyelitis who undergo a surgical approach often experience better outcomes than those treated solely through intravaneous antibiotics.

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