Vertebral osteomyelitis

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Clinical Features

  • Usually have had prolonged symptoms (pain >3mo)
  • At risk for recent bacteremia
  • Fever is a feature - however, often afebrile
  • Vertebral body tenderness
  • Paravertebral muscle spasm unreponsive to conservative therapy
  • Paravertebral or epidural abscess may develop

Differential Diagnosis

Spinal infection


  • ESR (almost always elevated)
  • Blood cultures
  • Imaging
    • May take 2-8 weeks to see changes
    • Bony destruction, irregularity of vertebral end places, disk space narrowing


  • Antibiotics
    • Usually requires IV antibiotic x6wk, then PO antibiotic x 4-8wk
    • Consult with spine surgeon before starting antibiotics (may interfere with biopsy culture)
    • Piperacillin-tazobactam 3.375gm IV + vancomycin 1gm IV


  • Normally, initially inpatient treatment