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DeWald, Christopher et al.: 2024 Spinal Deformities DOI: 10.1055/b-0044-203472
Section IV-A Adult Spinal Deformities

49 Vertebral Osteomyelitis in the Adult

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Editors: DeWald, Christopher; DeWald, Ronald L.

Authors: Ackshota, Nissim; Ahn, Nicholas U.; Alazzeh, Mohanad; Albert, Todd J.; Algattas, Hanna; An, Howard S.; Anari, Jason B.; Arlet, Vincent; Asher†, Marc A.; Belanger, Evan H.; Blakemore, Laurel C.; Blanke, Kathleen M.; Bondar, Kevin; Buchowski, Jacob M.; Bunch, Joshua T.; Burton, Douglas C.; Cahill, Patrick J.; Campbell, Robert; Carl, Allen L.; Caruso, Steven; Cerpa, Meghan; Charosky, Sebastien; Cognetti, Daniel J.; Crawford, Alvin H.; Crawford III, Charles H.; Cui, Shari; Daffner, Scott D.; Dede, Ozgur; Dekutoski, Mark B.; DeWald, Christopher J.; Dormans, John P.; Drayer, Nicholas J.; Drummond†, Denis S.; Emery, Sanford E.; Farcy, Jean-Pierre C.; Farrell, James P.; Fontes, Ricardo B. V.; Forsthoefel, Craig; Frost, Chelsea; Gaines, Robert W.; Gandhi, Sapan D.; Gehrchen, Martin; Glassman, Steven D.; Guiroy, Alfredo; Gupta, Munish C.; Ha, Alex S.; Hadeed, Michael M.; Haher, Thomas R.; Hamill, Christopher L.; Hamilton, D. Kojo; Hariharan, Arun R.; Harrop, James S.; Hashmi, Sohaib Z.; Hassanzadeh, Hamid; Heydemann, John A.; Horowitz, Jason A.; Howard, Roland; Hu, Ming-Hsiao; Hu, Serena S.; Hwang, Steven W.; Iyer, Sravisht; Jain, Amit; Jain, Viral V.; Janjua, M. Burhan; Jorgensen, Anton; Kang, Daniel G.; Kawakami, Noriaki; Kebaish, Khaled M.; Kelly, Michael P.; Kim, Han Jo; Labaran, Lawal A.; Lafage, Virginie; Laratta, Joseph L.; Lehman, Ronald A.; Lenke, Lawrence G.; Loder, Randall T.; Lonstein, John E.; Louie, Philip K.; Lubicky, John P.; Malik, Mohammad Saad; Marco, Rex A.W.; Mardjetko, Steven M.; Marrache, Majd; Maslak, Joseph P.; McCarthy, Michael H.; Melikian, Rojeh; Miller, Catherine; Min, Kan; Moquin, Ross R.; Morrison, Pamela R.; Mummaneni, Praveen V.; Nelson, Scott; Newton, Peter O.; Nolte, Michael T.; O’Brien†, Michael F.; Oetgen, Matthew E.; Ogilvie, James W.; Pannu, Tejbir S.; Petfield, Joseph L.; Riccio, Alexander R.; Roussouly, Pierre; Rymarczuk, George; Saifi, Comron; Salari, Pooria A.; Samdani, Amer F.; Sanders, James O.; Sarwark, John F.; Schwab, Frank J.; Sebaaly, Amer; Sengupta, Dilip K.; Shafi, Karim; Shah, Suken A.; Sheha, Evan D.; Shen, Francis H.; Shimer, Adam L.; Shtewe, Anan H.; Singla, Priyanka; Sponseller, Paul; Staub, Blake N.; Stricsek, Geoffrey P.; Sturm, Peter F.; Suk, Se-Il; Theologis, Alekos A.; Thompson, George H.; Thottempudi, Santan; Uribe, Juan S.; Vivas, Andrew C.; Wallace, Christopher S.; Witte, Zackery W.; Wood, Kirkham B.; York, Philip J.; Yu, Henry H.; Zebala, Lukas P.; Zhang, Bo; Zhao, Yiyu

Title: Spinal Deformities

Subtitle: The Comprehensive Text

Print ISBN: 9781626233720; Online ISBN: 9781684203604; Book DOI: 10.1055/b000000246

2. Edition © 2024. Thieme. All rights reserved.
Thieme Medical Publishers, Inc., New York

Subjects: Neurosurgery;Orthopaedics and Trauma Surgery

Thieme Clinical Collections (English Language)



 
Shari Cui and Sanford E. Emery

Abstract

Vertebral osteomyelitis remains a serious disease associated with a small but present risk of mortality. Spinal infections have played an important role in the development of spine surgery with posterior spinal fusions initially described to treat spinal infections. Pyogenic vertebral osteomyelitis is believed to arise from hematogenous spread of bacteria into the metaphyseal region of the vertebral body. The mostly avascular disk space becomes involved early leading to easy destruction of the disk space. However, diagnosis is often delayed due to the paucity of clinical symptoms in the early stages. Patients present with increasing back pain but are often afebrile, with a normal white blood count and normal radiographs.

A high index of suspicion is needed especially in immunocompromised patients. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) can help with the diagnosis, but MRI is the gold standard in the diagnosis of vertebral osteomyelitis and diskitis. Biopsy for diagnosis and culture data is a critical step in the evaluation and management of this disease but can often fail to reveal the definitive organism. The cornerstone of nonoperative treatment for diskitis or vertebral osteomyelitis is 6 weeks of intravenous antibiotics. However, surgical intervention is often required for neurologic deficit, spinal instability or deformity, or failure of nonoperative treatment. Surgical approach is dependent upon the regional anatomy of the spine, the location of the neuro-compression (anterior vs. posterior), the degree of vertebral destruction or instability, and the immunocompetence of the host.

Key words

diskitis - vertebral osteomyelitis - infection - neurologic deficit - epidural abscess
 
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