Pyogenic osteomyelitis of the spine--a review of 16 consecutive cases

Pyogenic osteomyelitis of the spine is an uncommon disease. A series of 16 cases is reported. The site of involvement includes the lumbar, cervical, and thoracic segments, in that order of frequency of occurrence. Drug addiction and diabetes mellitus are important predisposing factors. The spectrum of clinical presentation is described. Late presentation is usually masked by old age, debilitation, and previous antibiotic treatment. Rapid progression with septicemia is also encountered. The importance of differentiating this condition from tuberculosis spondylitis is emphasized. Definitive diagnosis should depend on bacteriological, histological, and, with the recent introduction of antituberculosis antibody test, serological studies. Timely surgical intervention is indicated in complicated cases. Radical excision and anterior spinal fusion yields early and complete eradication of the infected material plus arthrodesis, which prevents late collapse of the spine.