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Pyogenic vertebral osteomyelitis

E J Carragee1

  • 1Stanford University Medical Center, California 94305, USA. carragee@leland.stanford.edu

The Journal of Bone and Joint Surgery. American Volume
|June 1, 1997
PubMed
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Pyogenic vertebral osteomyelitis is common in older adults and those with compromised immunity. Early diagnosis and treatment, especially for Staphylococcus aureus infections, improve outcomes and reduce mortality.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Radiology

Background:

  • Pyogenic vertebral osteomyelitis (PVO) is a serious spinal infection.
  • Older adults and immunocompromised individuals are at higher risk.
  • Early diagnosis is crucial for effective management.

Purpose of the Study:

  • To retrospectively review the characteristics and outcomes of 111 patients with PVO.
  • To identify predictors of successful non-operative treatment.
  • To evaluate treatment strategies and patient outcomes.

Main Methods:

  • Retrospective review of 111 patient records with PVO.
  • Analysis of patient demographics, immune status, diagnostic methods (including MRI), causative organisms, infection sources, and treatment outcomes.

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  • Identification of independent variables predicting non-operative treatment success.

    • Main Results:

    • The mean age was 60 years; 55% were ≥60 years old.
    • 40% had impaired immune systems.
    • Staphylococcus aureus was the most common pathogen (36%).
    • Urinary tract infections were the most frequent source.
    • Predictors of successful non-operative treatment included younger age (<60), intact immune status, S. aureus infection, and decreasing erythrocyte sedimentation rate.
    • No late recurrence of infection was observed in patients followed for ≥2 years postoperatively.

    Conclusions:

    • PVO affects older and immunocompromised individuals, with S. aureus being a frequent pathogen.
    • Early diagnosis, often aided by MRI, and appropriate treatment are key to favorable outcomes.
    • Predictors for successful non-operative management were identified.
    • Surgical intervention (debridement and arthrodesis) was effective, with or without instrumentation.
    • Mortality was associated with early diagnosis, acute postoperative complications, and paraplegia, but long-term recurrence was rare.