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Pyogenic spinal osteomyelitis: a review of 61 cases.

K G Silverthorn, W J Gillespie

    The New Zealand Medical Journal
    |February 12, 1986
    PubMed
    Summary

    Nontuberculous spinal osteomyelitis, often caused by Staphylococcus aureus, presents subacutely with back pain but can lead to severe disability or death. Prompt diagnosis and management are crucial for satisfactory outcomes in this serious spinal infection.

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    Area of Science:

    • Orthopedics
    • Infectious Diseases
    • Spinal Surgery

    Background:

    • Nontuberculous spinal osteomyelitis is an uncommon yet serious condition.
    • It often presents with subacute back pain but can manifest with severe complications like sepsis or neurological deficits.
    • Preceding infections in the urinary, respiratory, dental, or abdominal regions are associated with its development.

    Purpose of the Study:

    • To review the clinical presentation and outcomes of nontuberculous spinal osteomyelitis.
    • To identify common causative organisms and risk factors.
    • To propose an algorithm for the investigation and management of this condition.

    Main Methods:

    • Retrospective review of 61 cases of nontuberculous spinal osteomyelitis.
    • Analysis of clinical presentation, diagnostic delays, causative organisms, and patient outcomes.
    • Development of a management and investigation algorithm.

    Main Results:

    • The most common presentation was subacute back pain, predominantly in infections caudal to the fourth thoracic vertebra.
    • Staphylococcus aureus was identified in 85% of cases.
    • Significant delays in diagnosis were noted, with 10% experiencing septicaemia and 7% developing paraperesis or paraplegia.
    • Four deaths and seven cases of severe disability were recorded, though overall outcomes were satisfactory for most patients.

    Conclusions:

    • Nontuberculous spinal osteomyelitis requires prompt diagnosis and effective management to prevent severe morbidity and mortality.
    • An evidence-based algorithm can guide the investigation and treatment of this challenging spinal infection.
    • Staphylococcus aureus is the primary pathogen, necessitating targeted antimicrobial therapy.

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