Vertebral osteomyelitis is a rare but serious infectious disease that causes inflammation and destruction of the spinal vertebrae. Prompt diagnosis and treatment are essential to avoid adverse outcomes. This article reviews risk factors for vertebral osteomyelitis, disease mechanisms, signs and symptoms, and diagnostic criteria. Medical imaging techniques for vertebral osteomyelitis are a main focus, and treatment, prognosis, and possible complications also are discussed. Finally, the special case of pediatric patients with vertebral osteomyelitis is presented.

The term spondylodiscitis describes the infection of both the intervertebral disc space and the adjacent vertebrae. Pyogenic Vertebral Osteomyelitis (PVO) is more common in older patients (mean age 59-69 years) with a male preponderance (52-69%). Recent studies reported an alarming increase of incidence over the last 20 years, due to the increase of diagnostic sensibility, the increase of the average lifetime and to the consequent association of chronic disabling pathologies, of immunosuppression, of surgical or invasive procedure. Improvements in radiological diagnosis, surgical techniques, and management of antimicrobial therapy have greatly improved PVO clinical outcome, but morbidity remains significant mostly because of the delay of diagnosis. The non-specific features of this infection can lead to underestimate the patient conditions, ending to a significant delay in diagnosis, reported from 30 to 90 days, and consequently to severe impairments, such as spine deformity and permanent neurological deficit. The duration of medical treatment is not yet established, and further randomized trials are needed to define it.

Vertebral Osteomyelitis and the Role of Imaging.

Spondylodiscitis: is really all well defined?

A 14-year-old previously healthy girl presented with atraumatic onset of low back and flank pain and mildly elevated inflammatory markers. Magnetic resonance imaging disclosed an L5 superior endplate fracture, and cultures grew methicillin-susceptible Staphylococcus aureus. We discuss the variable presentations and appropriate treatments of adolescent vertebral osteomyelitis.

background

Adolescent vertebral osteomyelitis mimicking a neoplasm.

Vertebral osteomyelitis is a rare diagnosis and often delayed diagnosis in children. This is a case of a child presenting with fever, back pain and raised C reactive protein who was found to have a Staphylococcus aureus (S.aureus) bacteraemia. Initial imaging with CT, MRI of the spine and abdominal ultrasound failed to demonstrate a vertebral osteomyelitis or identify another source of the bacteraemia. Due to the high clinical suspicion of a spinal source of the infection, second-line investigations were arranged. A bone scan identified an area of increase metabolic activity in the 12th thoracic vertebrae (T12) and subsequently a diagnosis was confirmed with a focused MRI of T12. This serves as an opportunity to discuss the diagnostic difficulty presented by paediatric vertebral osteomyelitis and more generally the need for clinicians to pursue their clinical suspicion in the face of false negative results to make an accurate and timely diagnosis.

https://casereports.bmj.com/content/bmjcr/14/1/e236037.full.pdf

Vertebral Osteomyelitis and the Role of Imaging.

Citations

Spondylodiscitis: is really all well defined?

Adolescent vertebral osteomyelitis mimicking a neoplasm.

Difficulties in diagnosing vertebral osteomyelitis in a child.