Vertebral osteomyelitis

Background

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

Evaluation

  • 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

Management

  • 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

Disposition

  • Normally, initially inpatient treatment

References

Authors:

Ross Donaldson