Vertebral Osteomyelitis

Vertebral osteomyelitis is an infection of the disc and/or vertebral body of the

spine. Patients are typically treated with 6 weeks of IV antibiotics. Patients with
an abscess may require an open vs. percutaneous drainage.

History

• Have you had any fevers, night sweats, or chills?

• Do you have pain at night?
• Do you have any weakness, numbness, or tingling?
• ROS for infectious sources (i.e., PNA, UTI, immunosuppressed) Do you use IV
drugs?

Physical Exam

• Complete Neurologic Exam (Appendix A)

Diagnosis

Imaging

• XRs—AP, lateral
• MRI with gadolinium contrast—hyperintensity seen on T2 sequence of disc and
endplate. Sensitive and specific. MRI is preferred imaging following X-rays

© Springer International Publishing Switzerland 2017 95

M.C. Makhni et al. (eds.), Orthopedic Emergencies,
DOI 10.1007/978-3-319-31524-9_26
96 M.C. Makhni et al.

• Technetium Tc99m bone scan—Sensitive but not specific

• CT—Demonstrates osseous involvement

Workup

• If patient stable, hold antibiotics prior to drawing blood cultures

• If Blood Cultures Are Negative
– Typically CT-guided biopsy
– If CT-guided biopsy not readily available, open biopsy can be done

Treatment

Non-operative (Most Patients)

• Minimum 6 weeks of IV antibiotics

• Consult with infectious disease team
• If patient is critically ill, consider empiric antibiotics
• Bracing
• For symptomatic improvement of pain and possible prevention of deformity
• Lumbar spine—Molded contact brace
• Cervical spine—Cervicothoracic orthosis or halo

Operative Management

• Necessary for abscess drainage

• CT-guided drainage is often sufficient
• Structural instability
• Failure of medical management
• Surgical debridement necessary for patients with spinal instrumentation