Abstract
Introduction: Haematogenous pyogenic spinal infection encompasses spondylodiskitis, septic discitis, vertebral osteomyelitis and epidural abscess. Management of pyogenic spinal infection can involve conservative methods and surgical intervention. We carried out a retrospective review of 48 cases of pyogenic vertebral osteomyelitis presenting over a twelve-year period to the National Spinal Injuries Unit of the Republic Of Ireland. Our objective was to analyze the presentation, aetiology, management and outcome of 48 cases of non-tuberculous pyogenic spinal infection.
Methods: Both the Hospital Inpatient Enquiry (HIPE) System and the National Spinal Injuries Unit Database were used to identify our study cohort. The medical records, blood results, radiologic imaging and bacteriology results of all patients identified were reviewed.
Results: The average age of presentation was 59 years with an almost even distribution between males and females. Most patients took between three and six weeks to present to hospital. Diagnosis was confirmed by serological testing of inflammatory markers and radiological imaging. The most frequently isolated pathogen was Staph. aureus (75% of cases). 94% of cases were managed by conservative measures alone, including antibiotic therapy and spinal bracing. However, in 6% of cases surgical intervention was required due to neurological compromise or mechanical instability.
Conclusions: With this large cohort of non-tuberculous, pyogenic spinal infections from the NSIU, we conclude that Staph. aureus is the predominent pathogen. In the vast majority, conservative management with antibiotic therapy and spinal bracing is very successful. However in 6% of cases surgical intervention is warranted and referral to a specialist centre is appropriate.
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