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...
...er, (S/L)675...
...ated ESR or CRP, (S/L)675...
...dstream infection or infective endocarditis. (...
...ver and new neurologic symptoms with...
new localized neck or back pain, following a re...
...ecommends performing a pertinent medica...
IDSA recommends obtaining bacterial (aerobic...
IDSA recommends a spine MRI in patients with sus...
...a combination spine gallium/Tc99 bone scan, or Co...
...ommends obtaining blood cultures and sero...
...gests obtaining fungal blood cultures i...
...ts performing a purified protein derivative (PPD...
...ients with suspected NVO, evaluation...
...recommends an image-guided aspiration bio...
...against performing an image-guided aspirati...
...vises against performing an image-guid...
...ith neurologic compromise with or w...
...A suggests the addition of fungal, mycobacterial,...
...e addition of fungal and mycobacteri...
...dequate tissue can be safely obtained, patholo...
...f concomitant bloodstream infection, IDSA...
...ients with a non-diagnostic first i...
In patients with suspected NVO and a non-...
Treatment
...Treat...
...An...
...tients with normal and stable neurologic e...
...nts with hemodynamic instability,...
...ecommends a total duration of 6 weeks of parenter...
IDSA recommends a total duration of 3 m...
...Surgery...
...s surgical intervention in patients wit...
...s surgical debridement with or without stabiliz...
...against surgical debridement and/o...
Follow-Up
Fol...
...Systemic Infla...
...monitoring systemic inflammatory marke...
...recommends against routinely ordering f...
...suggests performing a follow-up MR...
...Failure of Therapy...
...that persistent pain, residual neurologic...
...ients with NVO and suspected treatment failure...
...recommends obtaining a follow-up MRI with emphasi...
...patients with NVO and clinical and radiographic...
...nts with NVO and clinical and radiographic evide...
...igure 1. Evalu...
...ure 2. Managem...
.... Parenteral Antimicrobial Treatment...
...ble 2. Selected Oral Antibacterial Ag...