Vertebral osteomyelitis

Infections of the vertebra and neighboring disc create the characteristic lesions of vertebral osteomyelitis. The incidence has been estimated to range from 0.3 to 6.5 cases/100,000 persons. The hematogenous route of infection is predominant while direct inoculation through iatrogenic procedures and contiguous spread from adjacent tissue are rare. Most patients with hematogenous vertebral osteomyelitis exhibit predisposing factors, such as advanced age and diabetes mellitus. Diagnosis is often delayed due to the nonspecific nature of back pain, the main symptom. Furthermore, fever is frequently absent. Staphylococcus aureus is the most prevalent pathogen of pyogenic vertebral osteomyelitis in Europe. Magnetic resonance imaging (MRI) is the method of choice for the radiological diagnosis and blood cultures belong to the standard procedures. In cases of negative blood cultures a biopsy is generally warranted for microbiological diagnosis, either by computed tomography (CT)-guided needle biopsy or open surgery. Randomized trials that have addressed different antibiotic regimens are lacking. The recommended duration of treatment ranges from 6 weeks to 3 months. Patients with abscesses and implant devices in particular should be treated for 3 months.