Vertebral Osteomyelitis and Spinal Epidural Abscess

Abstract

Spinal infections have historically been associated with significant morbidity and mortality. Current treatment protocols have improved patient outcomes through prompt and accurate infection identification, medical treatment, and surgical interventions. Medical and surgical management, however, remains controversial because of a paucity of high-level evidence to guide decision making. Despite this, an awareness of presenting symptoms, pertinent risk factors, and common imaging findings are critical for treating spine infections. The purpose of this article is to review the recent literature and present the latest evidence-based recommendations for the most commonly encountered primary spinal infections: vertebral osteomyelitis and epidural abscess.

Staphylococcus aureus-Associated Musculoskeletal Infections

“…Vertebral osteomyelitis is almost always of hematogenous origin with endocarditis, catheter infections, skin and soft tissue infections, urinary tract, dental infections, and intravenous drug abuse being the most common primary source of infection (Zimmerli 2010;McHenry et al 2002). More seldom, inoculation can occur by direct inoculation after penetrating trauma, open fractures, postoperatively or from a spreading infection of the surrounding soft tissue (Berbari et al 2015;Boody et al 2015;Zimmerli 2010). As for other localizations of hematogenous osteomyelitis, S. aureus is most commonly isolated (up to 67 %) (Babouee Flury et al 2014;Grammatico et al 2008;Boody et al 2015).…”

“…Vertebral osteomyelitis is accompanied by complications due to seeding in different compartments, which leads to paravertebral, epidural, or psoas abscesses (Zimmerli 2010). Neurological complications could be observed in about 35 % of the cases (Boody et al 2015;Pigrau et al 2005). Diabetes mellitus, i. v. drug abuse, systemic infections, obesity, malignancy, immunodeficiency, malnutrition, and smoking are known to be risk factors for the development of a vertebral osteomyelitis (Boody et al 2015;Zimmerli 2010).…”

“…Neurological complications could be observed in about 35 % of the cases (Boody et al 2015;Pigrau et al 2005). Diabetes mellitus, i. v. drug abuse, systemic infections, obesity, malignancy, immunodeficiency, malnutrition, and smoking are known to be risk factors for the development of a vertebral osteomyelitis (Boody et al 2015;Zimmerli 2010). Next to general clinical signs of infections such as fever, chills, weight loss, swelling, or redness, the clinical picture of vertebral osteomyelitis is characterized by severe back pain on the site of infection, muscle spasms, painful or difficult urination, and neurological deficits in 10-20 % (radiculopathy, myelopathy) as a result of direct infection spreading on neural elements, compression due to an epidural abscess, or compression due to spine instability.…”

“…Samples are collected either intraoperatively or through CT-guided biopsy sampling of the vertebra. Imaging tools are necessary to diagnose this kind of infection and to determine the location of infection, whereas an X-ray imaging is the first choice tool followed by CT-scan, which demonstrates bone destruction, and MRI for soft tissue infection involvement (Berbari et al 2015;Boody et al 2015;Zimmerli 2010) (Fig. 6).…”

“…More seldom, inoculation can occur by direct inoculation after penetrating trauma, open fractures, postoperatively or from a spreading infection of the surrounding soft tissue (Berbari et al 2015;Boody et al 2015;Zimmerli 2010). As for other localizations of hematogenous osteomyelitis, S. aureus is most commonly isolated (up to 67 %) (Babouee Flury et al 2014;Grammatico et al 2008;Boody et al 2015). About 50-60 % of the cases occur in the lumbar spine, 30-40 % in the thoracic spine, and about 10 % of infection manifestation occurs in the cervical spine (Zimmerli 2010).…”