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

...agnosis

...ever, (S/L)6...

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

...oodstream infection or infective endocarditis. (...


fever and new neurologic symptoms with or wi...

...localized neck or back pain, following a r...


...ecommends performing a pertinent medical and a...


...obtaining bacterial (aerobic and anaero...


...s a spine MRI in patients with suspected...


...suggests a combination spine gallium/Tc99 bone s...


...ecommends obtaining blood cultures and...


...gests obtaining fungal blood cultures in patients...


...gests performing a purified protein derivative (P...


...with suspected NVO, evaluation by an infectious d...


...recommends an image-guided aspira...


...gainst performing an image-guided...


...ainst performing an image-guided aspiration biop...


...th neurologic compromise with or without impendin...


...s the addition of fungal, mycobacterial...


IDSA suggests the addition of fungal and mycobact...


...ate tissue can be safely obtained, pathol...


...the absence of concomitant bloodstream infection,...


...ents with a non-diagnostic first im...


...with suspected NVO and a non-diagnosti...


Treatment

...reatment...

Antibiotics

...atients with normal and stable neurologi...

...s with hemodynamic instability, seps...

...ecommends a total duration of 6 weeks of parent...

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


...urger...

...surgical intervention in patients with progr...

...urgical debridement with or without stabilizati...

...against surgical debridement and/or stabilization...


Follow-Up

Follow...

...Inflammatory Markers and MRI...

...ggests monitoring systemic inflammatory marke...

...against routinely ordering follow-up...

...performing a follow-up MRI to assess evolutionary...


...e of Therapy...

...that persistent pain, residual neurologic deficits...

...with NVO and suspected treatment failure, IDSA su...

...mmends obtaining a follow-up MRI w...

...ients with NVO and clinical and radiographic...

...h NVO and clinical and radiographic evidence of...

Figure 1. Evalua...

...igure 2. Manag...

...e 1. Parenteral Antimicrobial Treatment of Comm...

...ble 2. Selected Oral Antibacterial...