Pyogenic Vertebral Osteomyelitis: Report of Nine Cases and Review of the Literature

Abstract

Nine cases of pyogenic vertebral osteomyelitis from the present series and 309 cases from the literature were reviewed. Elderly males and diabetics were found to be particularly susceptible to the disease. Neck or back pain was present in 92% of the patients and lasted for longer than three months in >50%. Atypical symptoms, such as chest or abdominal pain, were seen in 15%. The erythrocyte sedimentation rate was elevated consistently, but only about 50% of patients had fever or leukocytosis. The urinary tract was the most common source of infection (28.5%). The lumbar region was the most commonly involved site (48%). Narrowing of disk spaces with vertebral end-plate involvement on X ray was seen in 74% of the cases. Staphylococcus aureus was the causative organism in 55% of cases. Parenteral antibiotic therapy for four weeks or longer resulted in a good response, but shorter courses of therapy resulted in higher rates of failure. The erythrocyte sedimentation rate fell to one-half to two-thirds of pretherapy levels by the completion of successful therapy. Bed rest was an adequate mode ofimmobilization in most cases. The death rate was lower than 5%, and the rate of residual neurologic deficits was lower than 7%. Permanent neurologic damage was significantly more frequent in diabetic patients. Early diagnosis and prompt, aggressive therapy should result in minimal complications, residual neurologic deficits, and low mortality.