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
...agnosi...
...er, (S/L)675
...d ESR or CRP, (S/L)6...
...omitant bloodstream infection or infective...
...ver and new neurologic symptoms with or without ba...
...localized neck or back pain, follo...
...commends performing a pertinent me...
...ommends obtaining bacterial (aerobic and anae...
...A recommends a spine MRI in patients with susp...
IDSA suggests a combination spine gallium/...
...ommends obtaining blood cultures and serology...
...obtaining fungal blood cultures in patient...
...uggests performing a purified protein derivativ...
...nts with suspected NVO, evaluation by an i...
...mmends an image-guided aspiration biopsy in patien...
...vises against performing an image-guided as...
...ises against performing an image-guided aspiratio...
...ents with neurologic compromise with or wit...
...suggests the addition of fungal, mycobacteria...
...SA suggests the addition of fungal and mycobacteri...
...ue can be safely obtained, pathology speci...
...of concomitant bloodstream infection, IDS...
...n patients with a non-diagnostic first image-g...
...ents with suspected NVO and a non-d...
Treatment
...eatment...
...ntibioti...
...ents with normal and stable neurologic...
...with hemodynamic instability, sepsis, sept...
...recommends a total duration of 6 weeks...
...mmends a total duration of 3 month...
...rgery...
...surgical intervention in patients with progressi...
...gests surgical debridement with or wit...
...ses against surgical debridement and/or st...
Follow-Up
Follow-...
...ic Inflammatory Markers and MRI...
IDSA suggests monitoring systemic inflamma...
...against routinely ordering follow-up MRI...
...sts performing a follow-up MRI to as...
...e of Therapy...
...ts that persistent pain, residual neurol...
...NVO and suspected treatment failure, IDSA s...
...recommends obtaining a follow-up MRI with emp...
...ents with NVO and clinical and rad...
...atients with NVO and clinical and radiographic e...
...ure 1. Evaluati...
...2. Management...
...Parenteral Antimicrobial Treatment of Com...
...cted Oral Antibacterial Agents with Excellent O...