Vertebral osteomyelitis in Qatar

Twenty-eight cases of vertebral osteomyelitis were diagnosed at Hamad General Hospital in Qatar between January 1988 and December 1991: 16 (57.2%) cases were tuberculous spondylitis, 6 (21.4%) Brucella spondylitis, 3 (10.7%) Staphylococcus aureus spondylitis, 2 (7.1%) Salmonella spondylitis, and 1 (3.6%) Pseudomonas cepacia spondylitis. Plain vertebral x-ray films and CT scans were abnormal in all patients. Bone and gallium scans were abnormal in 87.5% and 64% of cases respectively. Clinical manifestations, haematological and radiological investigations were not able to differentiate between the causes. Serological tests were helpful in diagnosing Brucella spondylitis. CT-guided needle biopsy was able to identify the aetiology in 90% of cases. We conclude that invasive tests are still needed to establish the microbiological diagnosis and to guide antimicrobial therapy in most cases of vertebral osteomyelitis.