Vertebral osteomyelitis in paraplegia: incidence, risk factors, clinical picture

Because vertebral osteomyelitis (VOM) appears to be relatively common among patients paralyzed due to myelopathy, a population of these patients was surveyed to A) estimate the incidence of VOM, B) identify risk factors, and C) review clinical features.

The cohort of 537 patients with myelopathy paralyzed prior to January 1, 1989 and subsequently hospitalized at the authors' facility over an 11-year survey period was surveyed. All were male, 93% had a traumatic etiology of paralysis, 50% were > or = 50 years of age, 53% were paraplegic, 54% were motor and sensory complete, and 56% had been paralyzed for 15 years or more. VOM was diagnosed by computerized tomographic demonstration of intervertebral end plate destruction and a positive culture of that site. The relative incidences of VOM were calculated as cases per spinal cord injury (SCI) and general hospitalizations; potential risk factors were assessed by rates of VOM in the myelopathy cohort and clinical features of VOM in these patients were noted.

Ten patients with myelopathy developed VOM, an incidence of 20.9 cases/10,000 SCI versus 1.8 cases/10,000 general hospitalizations. The risk ratio was 7.1 (p = .05) for paraplegia, 7.9 (p = .04) for motor and sensory completeness, and 4.4 (p = .06) for diabetes mellitus. The risk ratio for the 3 factors combined was 14.5 (p = .001). Initial clinical presentations were notable for back pain and plain radiographic films revealing paraspinal masses and pleural effusion.

Patients with myelopathy are uniquely at risk for VOM if their paralysis is at the paraplegic level and is motor and sensory complete.