Pyogenic Vertebral Osteomyelitis: A Systematic Review of Clinical Characteristics

Mylona, Eleni; Samarkos, Michael; Kakalou, Eleni; Fanourgiakis, Panagiotis; Skoutelis, Athanassios

doi:10.1016/j.semarthrit.2008.03.002

Cited by 539 publications

(479 citation statements)

References 22 publications

Supporting

Mentioning

405

Contrasting

Unclassified

Order By: Relevance

“…On the other hand, a systematic review in English literature reported that the infection rate of MRSA was only 3% of patients with this infection (Mylona et al 2008). In the present study, we showed that 16% of the patients with this disorder (4 out of 25 patients) were infected by MRSA or MRSE.…”

Section: Discussionsupporting

confidence: 44%

Atypical Findings on Magnetic Resonance Imaging in the Patients with Active Pyogenic Spondylitis in Japanese University Hospitals

Aizawa

Ozawa

Koakutsu

et al. 2013

Tohoku J. Exp. Med.

View full text Add to dashboard Cite

Recently, aging population and immuno-compromised patients have been rising in Japan. Accordingly, patients with pyogenic spondylitis have been increasing and may present atypical clinical features. University hospitals treat many elderly patients and patients with poor general condition. Therefore, patients with pyogenic spondylitis treated at two university hospitals were retrospectively investigated to clarify the recent clinical and radiologic characteristics of this infection. There were 30 patients (average age: 68 years) treated in two university hospitals between 2009 and 2010. The onset was acute or subacute in 15 patients, insidious in 7 and unclassified in 8. Culture tests were performed in 25 patients, and the causative microorganisms were identified in 20 patients with the identification rate of 80%, including 4 patients infected by methicillin-resistant staphylococci. Classically, active pyogenic spondylitis is characterized by typical findings on magnetic resonance imaging (MRI): obvious signal decrease in T1-weighted image (WI) and increase in T2WI with contrast enhancement found in most of the bodies of two adjacent vertebrae and the intervening intervertebral disc. Among 29 patients with active pyogenic spondylitis, whose lesions were not in the healing stage, 16 patients demonstrated at least one of the atypical MRI findings; 9 patients showed involvement ≥ 3 vertebrae or only 1 vertebra, 5 showed the signal changes of the lesions involving small, spotty, or faint areas, and 3 showed small vertebral lesions but larger epidural or paraspinal abscesses. In conclusion, currently, about half of the patients with pyogenic spondylitis demonstrate atypical MRI findings in the university hospitals in Japan.

show abstract

Section: Discussionsupporting

confidence: 44%

Atypical Findings on Magnetic Resonance Imaging in the Patients with Active Pyogenic Spondylitis in Japanese University Hospitals

Aizawa

Ozawa

Koakutsu

et al. 2013

Tohoku J. Exp. Med.

View full text Add to dashboard Cite

show abstract

“…4 Moreover, abnormalities on plain radiographs generally occur several weeks after the onset of the infection. 2 We suspected the osteomyelitis had developed at the first admission, and the second admission could be related to the relapse after incomplete treatment. The diagnosis of vertebral osteomyelitis required a high index of clinical suspicion, prompt image evaluation and a tissue proof.…”

Section: Discussionmentioning

confidence: 95%

“…1 Vertebral osteomyelitis often presented with back pain, fever, tenderness at the vertebral body and sometimes neurological symptoms related to spinal cord compression. 2 The above symptoms, except for fever, are mostly absent in the paraplegics. Severe vertebral osteomyelitis in SCI had been reported, and unsatisfactory response to antibiotic treatment might be the only clue for diagnosis for those without draining sinuses or fluctuant masses, 3 as in the reported case.…”

Section: Discussionmentioning

confidence: 98%

“…Without early detection and treatment, vertebral osteomyelitis can result in severe bone destruction, paraspinal abscess, epidural abscess and even mortality. 2 …”

Section: Discussionmentioning

confidence: 99%

“…1 Nevertheless, classic symptoms of vertebral osteomyelitis, such as back pain, neurological deficits and vertebral body tenderness, 2 are mostly absent in SCI and it challenges the early diagnosis.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Delayed diagnosis of vertebral osteomyelitis in a paraplegic patient

Hsiao

Liang

2011

Spinal Cord

View full text Add to dashboard Cite

Study design: Case report. Objective: Vertebral osteomyelitis, usually presented with back pain and local tenderness, can pose a great challenge of early diagnosis among spinal cord injury (SCI) patients who lost sensation below the injured level. We reported a paraplegic patient who had recurrent febrile episodes after being treated as urinary tract infection initially and was discovered later to have vertebral osteomyelitis. Case report: A 41-year-old man, completely paralyzed at the T11 level and with Foley catheterization for 9 years, was re-admitted within 2 weeks for recurrent fever, turbid urine, bacteriuria and bacteremia with Escherichia coli. Spine X-ray and renal, cardiac and abdominal ultrasonography showed no definite lesions related to infection in a previous admission. Intermittently febrile episodes continued despite treatment with antibiotics for 1 week. He had no pressure sores or other wounds. Computerized tomography and magnetic resonance imaging showed lumbosacral osteomyelitis and bilateral paravertebral abscess. The patient underwent debridement of paravertebral tissue. Fever subsided soon after surgery and the patient continued antibiotics and remained free of fever at a 1-year follow-up. Conclusion: It can be challenging to diagnose vertebral osteomyelitis below injury levels in SCI patients. Vertebral osteomyelitis should be considered in febrile SCI patients even with known infectious foci, as classic symptoms of osteomyelitis are lacking in this population.

show abstract

Radiological Imaging of Spine Infection

Quintero¹,

Riascos²

2013

Diagnostic Imaging of Infections and Inflammatory Diseases

View full text Add to dashboard Cite

Pyogenic Vertebral Osteomyelitis: A Systematic Review of Clinical Characteristics

Cited by 539 publications

References 22 publications

Atypical Findings on Magnetic Resonance Imaging in the Patients with Active Pyogenic Spondylitis in Japanese University Hospitals

Atypical Findings on Magnetic Resonance Imaging in the Patients with Active Pyogenic Spondylitis in Japanese University Hospitals

Delayed diagnosis of vertebral osteomyelitis in a paraplegic patient

Radiological Imaging of Spine Infection

Contact Info

Product

Resources

About