Native Vertebral Osteomyelitis in Adults

Publication Date: July 29, 2015

Key Points

Key Points

Native Vertebral Osteomyelitis (NVO) in adults is often the result of hematogenous seeding of the adjacent disc space from a distant focus, since the disc is avascular.

NVO is commonly monomicrobial and most frequently due to Staphylococcus aureus.

The diagnosis of NVO is often delayed and often initially managed as degenerative spine disease.

NVO is typically diagnosed in the setting of recalcitrant back pain unresponsive to conservative measures and elevated systemic inflammatory markers with or without fever.

The majority of patients are cured with a 6 week course of antimicrobial therapy, but some patients may need surgical debridement and/or spinal stabilization during or after a course of antimicrobial therapy.

Diagnosis

...agnosi...

...ver, (S/L)...

...ESR or CRP, (S/L)675...

...itant bloodstream infection or infective endocardi...


...nd new neurologic symptoms with or witho...

...calized neck or back pain, following a recent e...


...s performing a pertinent medical and a motor...


...ommends obtaining bacterial (aerobic and an...


IDSA recommends a spine MRI in patients wi...


...suggests a combination spine gallium/Tc99 bo...


...ends obtaining blood cultures and serology tests f...


...suggests obtaining fungal blood cultures in pa...


...SA suggests performing a purified protei...


...ients with suspected NVO, evaluation by an infecti...


...commends an image-guided aspiration bi...


...advises against performing an imag...


...s against performing an image-guided...


...n patients with neurologic compromise with or w...


...SA suggests the addition of fungal, mycob...


...suggests the addition of fungal and mycobacte...


...ssue can be safely obtained, pathology specimen...


...bsence of concomitant bloodstream infect...


...ith a non-diagnostic first image-guided aspi...


...th suspected NVO and a non-diagnostic image-...


Treatment

Treatment

Antibiotic...

...n patients with normal and stable neurolog...

...with hemodynamic instability, sepsi...

...SA recommends a total duration of 6 weeks...

...recommends a total duration of 3 months of a...


Surge...

...recommends surgical intervention in patients...

...ests surgical debridement with or without sta...

...A advises against surgical debrideme...


Follow-Up

Follow-Up

...nflammatory Markers and MRI...

...ggests monitoring systemic inflammatory marker...

...DSA recommends against routinely ordering follow...

...performing a follow-up MRI to asses...


...re of Therapy...

...sts that persistent pain, residual...

...s with NVO and suspected treatment failure, IDS...

...ommends obtaining a follow-up MRI...

...tients with NVO and clinical and radiographic...

...tients with NVO and clinical and radiographic e...

...e 1. Evaluatio...

...re 2. Management...

...teral Antimicrobial Treatment of Common Micr...

...cted Oral Antibacterial Agents with Excel...