Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases

Abstract

Objectives-To describe a large series of patients with vertebral osteomyelitis (VO), and to compare the clinical, biological, radiological, and prognostic features of pyogenic (PVO), tuberculous (TVO), and brucellar vertebral osteomyelitis (BVO). Methods-A retrospective multicentre study, which included 219 adult patients with VO with confirmed aetiology, who were diagnosed between 1983 and 1995 in two tertiary care centres. Of these patients, 105 (48%) had BVO, 72 (33%) PVO, and 42 (19%) TVO. Results-One hundred and forty eight (67.6%) patients were male and 71 (32.4%) female. The mean (SD) age was 50.4 (16.4) years (range 14-84) and the mean (SD) duration of symptoms before the diagnosis was 14 (16.8) weeks. In 127 patients (57.9%) the vertebral level involved was lumbar, in 70 (31.9%) thoracic, and in 16 (7.3%) cervical. One hundred and nineteen patients (54.4%) received only medical treatment and 100 (45.6%) required both medical and surgical treatment. The presence of diabetes mellitus, intravenous drug abuse, underlying chronic debilitating diseases or immunosuppression, previous infections, preceeding bacteraemia, recent vertebral surgery, leucocytosis, neutrophilia, and increased erythrocyte sedimentation rate (ESR) were significantly associated to PVO. A prolonged clinical course, thoracic segment involvement, absence of fever, presence of spinal deformity, neurological deficit, and paravertebral or epidural masses, were significantly more frequent in the group of TVO. The need for surgical treatment and the presence of severe functional sequelae were more frequent in the groups of PVO and TVO. Conclusion-There are significant clinical, biological, radiological, and prognostic diVerences between BVO, PVO, and TVO. These diVerences can point to the causal agent and orient the initial empirical medical treatment while awaiting a final microbiological diagnosis. (Ann Rheum Dis 1997;56:709-715) In 1975 Ross and Fleming rightly pointed out "neither common enough to be readily recognizable, nor rare enough to be a medical curiosity, vertebral osteomyelitis (VO) represents a diagnostic challenge to the physician". 1The clinical picture of VO is rather nonspecific. It commonly starts insidiously and follows an indolent course making early diagnosis diYcult.2-4 Consequently, patients often develop highly destructive lesions or neurological complications related to compression of the spinal cord or its roots.

Spondylodiscitis in patients under haemodyalisis

“…f. X-ray after one-year follow-up (lateral view) spondylodiscitis. Other authors have reported similar delays [4,10,16,23]. Clearly mortality could be avoided with an earlier diagnosis.…”

“…The most frequent place for bacterial colonisation is the spine [23], frequently at the thoracolumbar junction. This situation together with late diagnosis provokes a higher mortality rate [4,15,16]. These patients are also immunocompromised, have advanced age, and suffer very frequently from concurrent diseases such as diabetes mellitus [9].…”

Lumbar epidural abscess caused by brucella species: report of two cases

“…The diagnosis is disclosed with history, physical examination, blood tests for brucellosis, and radiological and histopathological means 8 . Positive blood culture is a definite diagnostic tool however proper use of culture techniques, preparation of several specimens and proper timing of culture particularly before administration of antibiotic treatment are the key features increasing the frequency of growth in culture 3,10,13 . Furthermore, culture of surgical or biopsy specimens could give another chance to reveal the presence of Brucella species.…”

“…Spinal abscess due to Brucella species should be treated both medically and surgically especially when neuroradiological images point to a severe mass effect on the neural structures. However, medical treatment could be an alternative to surgery in benign soft-tissue lesions in the absence of neurological deterioration 3,13 . Imaging studies for Brucella spondylitis do not give clues about definitive diagnosis 3,12 .…”

“…However, medical treatment could be an alternative to surgery in benign soft-tissue lesions in the absence of neurological deterioration 3,13 . Imaging studies for Brucella spondylitis do not give clues about definitive diagnosis 3,12 . Biopsy or surgical intervention is indicated to rule out other granulomatous lesions like tuberculosis when the diagnosis is indefinite despite neuroradiological and clinical studies 9,12 .…”