VERTEBRAL OSTEOMYELITIS CASES (1987-1991)

A retrospective chart review (June 1987 to September 1991) conducted at Charleston Area Medical Center identified 20 cases of pyogenic vertebral osteomyelitis, including five postlaminectomy cases and 15 cases attributed to the hematogenous spread of bacteria from a noncontiguous focus of infection. (This represents an average of about five cases per year, or 0.15 cases per 1,000 patient discharges.) Plain radiographs, technetium scans, computed tomograms, and magnetic resonance imaging scans were positive in 100%, 93%, 81%, and 91%, respectively, of patients who underwent these examinations and indicated that osteomyelitis involved the lumbosacral spine in 75% of cases. Positive blood cultures were obtained in 10 (59%) of 17 patients (a slightly higher proportion than previously reported), and positive vertebral cultures were obtained in 12 (71%) of 17 patients. The intravenous administration of appropriately selected antimicrobial agents for a minimum of 6 weeks in culture-positive patients, combined with immobilization and surgery in some cases, was followed by clinical resolution of osteomyelitis in all 20 patients.