Native Vertebral Osteomyelitis in Adults
Key Points
Key Points
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
...Diagn...
...r, (S/L)675...
...d ESR or CRP, (S/L)675...
...loodstream infection or infective endocarditis. (...
...d new neurologic symptoms with or without bac...
...neck or back pain, following a rece...
...SA recommends performing a pertinent medical...
...obtaining bacterial (aerobic and anaerobic)...
...SA recommends a spine MRI in patients wit...
...a combination spine gallium/Tc99 bone scan,...
...s obtaining blood cultures and serology tests for...
...sts obtaining fungal blood cultures...
...suggests performing a purified prot...
...n patients with suspected NVO, evaluation by an...
...commends an image-guided aspiration biopsy...
IDSA advises against performing an image-guided...
IDSA advises against performing an image-guided...
...patients with neurologic compromise with or...
...he addition of fungal, mycobacterial, or brucel...
IDSA suggests the addition of fungal an...
...adequate tissue can be safely obtained...
In the absence of concomitant bloodstr...
...nts with a non-diagnostic first image...
...ith suspected NVO and a non-diagnost...
Treatment
...Treatment
...Antibiotics...
...tients with normal and stable neurologic exam and...
In patients with hemodynamic instability...
...nds a total duration of 6 weeks of par...
...s a total duration of 3 months of antimicrobial...
...Surger...
...ds surgical intervention in patients with progres...
...surgical debridement with or without stabi...
IDSA advises against surgical debridement an...
Follow-Up
...Systemi...
...monitoring systemic inflammatory markers (ES...
...ends against routinely ordering follow-...
...erforming a follow-up MRI to assess evolution...
...Failure of Therapy...
...uggests that persistent pain, residual neurolo...
...ents with NVO and suspected treatment failure,...
...mends obtaining a follow-up MRI wi...
...with NVO and clinical and radiographic...
...h NVO and clinical and radiographi...
...gure 1. Evaluatio...
...igure 2. Manag...
...ble 1. Parenteral Antimicrobial Treatment...
...le 2. Selected Oral Antibacterial Agent...