DIAGNOSTIC AND THERAPEUTIC APPROACH TO VERTEBRAL OSTEOMYELITIS

Abstract

Most of the studies in the literature identify spondylodiscitis as a challenge for the physician: symptoms are not specific and sub-acute/chronic presentation is common. The question of when surgery is indicated is a frequent matter of debate. We want to present and validate our flow chart for spinal infections diagnosis and treatment.

A retrospective review of 128 cases of spinal infections presenting over a 10-year period was performed. Medical records, imaging (X-Rays, MRI with gadolinium, Ga-67 and Tc-99 bone scan), laboratory test and bacteriology results of 128 patients from 1997 to 2006 were reviewed.

The average age of presentation was 55 years (median age: 61 years, range: between 1 and 88 years) of 53 females and 75 males. Only one level was interested in 22% of the cases. The cervical spine was affected in 6% of cases, the thoracic spine in 37%, and the lumbosacral spine in 57%. Soft tissues have been affected in 16% of the patients. CT guided trocar biopsies were performed in 80 patients, incisional biopsies in 10 patients, and excisional biopsy in 1 case. No complication occurred. The most represented microorganisms which were identified were Staphylococcus Aureus and Mycobacterium Tuberculosis. Conservative treatment alone (antibiotic therapy and bracing) was performed in 84 cases out of 128 (66%); Forty-four patients with either neurologic compromise or mechanical instability or those who were unresponsive to drugs and immobilisation were submitted to surgical treatment.

Late diagnosis may lead to spinal deformities, prolonged hospital stay and more expensive management of the patient. Appropriate treatment usually brings to resolution even if spinal infections are rare and often misdiagnosed. We suggest an easy-to-follow flow-chart for the diagnosis and treatment of spinal infections.