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
...iagnos...
...er, (S/L)67...
...ESR or CRP, (S/L)675...
...bloodstream infection or infective endocardit...
...new neurologic symptoms with or without back pai...
...alized neck or back pain, following a recent...
...SA recommends performing a pertinent medical...
...nds obtaining bacterial (aerobic and anaerobic) bl...
IDSA recommends a spine MRI in patients...
...SA suggests a combination spine gallium/Tc9...
...nds obtaining blood cultures and serol...
...btaining fungal blood cultures in patients with su...
...A suggests performing a purified protein der...
...n patients with suspected NVO, evaluation by an...
...nds an image-guided aspiration biopsy in...
...s against performing an image-guided as...
...s against performing an image-guided aspiratio...
...nts with neurologic compromise with or wi...
...sts the addition of fungal, mycobacter...
...gests the addition of fungal and m...
...ate tissue can be safely obtained, patholo...
...absence of concomitant bloodstream infection...
...h a non-diagnostic first image-guide...
...th suspected NVO and a non-diagnostic image-gu...
Treatment
...eatment
...ntibioti...
...ith normal and stable neurologic exam and stable...
...with hemodynamic instability, sepsis, septic shoc...
...ds a total duration of 6 weeks of parenteral or h...
...a total duration of 3 months of antimic...
...rgery
...ds surgical intervention in patients with pro...
...suggests surgical debridement with or without st...
...SA advises against surgical debridemen...
Follow-Up
Follow-...
...Inflammatory Markers and...
...ggests monitoring systemic inflamm...
...s against routinely ordering follow-up MRI in pat...
...suggests performing a follow-up MRI t...
Failure of Th...
...suggests that persistent pain, residual neuro...
...with NVO and suspected treatment...
...recommends obtaining a follow-up MRI with emp...
...ts with NVO and clinical and radiographic...
...s with NVO and clinical and radiogra...
Figure 1. Eval...
...re 2. Management...
...le 1. Parenteral Antimicrobial Treatm...
...ted Oral Antibacterial Agents with Excell...