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
...agnosis...
fever, (S/...
elevated ESR or CRP, (S/L)...
...tant bloodstream infection or infecti...
...ver and new neurologic symptoms with or without ba...
...localized neck or back pain, following a recent...
...ecommends performing a pertinent med...
...recommends obtaining bacterial (aerobic and anaer...
...ommends a spine MRI in patients with s...
...DSA suggests a combination spine gall...
...mmends obtaining blood cultures and serolo...
...btaining fungal blood cultures in patie...
...suggests performing a purified protein deriva...
...ith suspected NVO, evaluation by an...
...ecommends an image-guided aspiration biopsy i...
...es against performing an image-guided...
...SA advises against performing an imag...
...with neurologic compromise with or...
...uggests the addition of fungal, mycobacterial, o...
...uggests the addition of fungal and m...
If adequate tissue can be safely obtaine...
...he absence of concomitant bloodstream in...
...with a non-diagnostic first image-gui...
...with suspected NVO and a non-diagnostic i...
Treatment
...eatmen...
...tibiotics
In patients with normal and stable neurologi...
...th hemodynamic instability, sepsis, septic sho...
...ends a total duration of 6 weeks of parenteral...
...DSA recommends a total duration of 3 mo...
...urgery
...ds surgical intervention in patients with pro...
...gests surgical debridement with or without stabi...
...ainst surgical debridement and/or stabi...
Follow-Up
...llow-Up...
...flammatory Markers and MRI...
...suggests monitoring systemic inflam...
...commends against routinely ordering foll...
...sts performing a follow-up MRI to...
...e of Therapy...
...s that persistent pain, residual neurologic defi...
...nts with NVO and suspected treatment failure, IDSA...
...ds obtaining a follow-up MRI with emphasis on ev...
...n patients with NVO and clinical and rad...
...with NVO and clinical and radiographic...
...ure 1. Evaluation...
...ure 2. Management
...teral Antimicrobial Treatment of Common Micr...
...e 2. Selected Oral Antibacterial Ag...