Information for Patients

Pyogenic vertebral osteomyelitis is the most commonly encountered form of vertebral infection. It can develop from penetrating wounds, infections in adjacent structures, hematogenous dissemination of bacteria to a vertebra, or spine surgery. Left untreated, it can lead to neurologic deficits, spinal deformity, or death. The disease may occur at any age; however, it more frequently affects the elderly. Patients with acute infection will have fever, local spine pain, severe muscle spasm, and limited spine motion. Hamstring tightness, loss of lumbar lordosis, a positive straight leg raising test, reluctance to bear weight, and hip flexion contracture caused by psoas irritation may be observed in patients with lumbar involvement. In patients with cervical osteomyelitis, torticollis and fever may be the only presenting signs. Neurologic deficit is seen in about 17% of patients and may result from direct compression of the spinal cord or nerve roots by epidural pus, granulation tissue, or bone and disk from the development of spinal deformity and instability. Nonsurgical treatment consists of maximum dose parenteral antibiotic therapy for 6 weeks, followed by oral antibiotic therapy until resolution of the disease. Indications for surgical intervention include failure of needle biopsy to obtain necessary cultures, clinically significant abscess with systemic toxicity, failure of intravenous antibiotics alone to eradicate the infection, neurologic deficits, significant osseous involvement, and upper cervical osteomyelitis.