Vertebral osteomyelitis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The term osteomyelitis describes any new infection in the bone and bone marrow. Vertebral osteomyelitis is a specific type of disease which describes a rare bone infection concentrated in the spinal region.[1]
Classification
The infection can be classified as acute or chronic depending on the severity of the onset of the case,[2] where acute patients often experience better outcomes than those living with the chronic symptoms that are characteristic of the disease.
Pathophysiology
Vertebral osteomyelitis often attacks two vertebrae and the corresponding intervertebral disk, causing narrowing of the disc space between the vertebrae.[3] A notable aspect of the disease is found in its ability to start anywhere in the body and spread to other regions through the bloodstream. A number of bacterial strains can enter the body in this manner, making the origin of the infection hard to trace; thus, for many patients with the infection, this characteristic can delay an accurate diagnosis and prolong suffering.
Differentiating Vertebral osteomyelitis from other Diseases
Diagnosis can also be complicated due to the disease's similarity to discitis, commonly known as an infection of the disc space. Both diseases are characterized by a patient's inability to walk and concentrated back pain; however, patients with vertebral osteomyelitis often appear more ill than those with discitis.[4] Additional measures may be called upon to rule out the possibility of discitis; such approaches include diagnosing the disease through various medical imaging techniques.
Diagnosis
X Ray
Radiological intervention is often necessary to confirm the presence of vertebral osteomyelitis in the body. Plain-film radiological orders are necessary for all patients displaying symptoms of the disease. This diagnostic approach is often preliminary to other radiological procedures, such as magnetic resonance imaging, or MRI, computed tomography (CT) scan, fine-needle aspiration biopsy, and nuclear scintigraphy. The initial plain-film X-ray images are scanned for any indication of disc compression between two vertebrae or the degeneration of one or more vertebrae. Only when these findings are ambiguous is further testing necessary to diagnose the disease. Other radiological approaches offer more comprehensive imaging of the spinal area, but can often prove inconclusive.
CT
If MRI imaging is inconclusive, the high sensitivity to erosions in the vertebrae or intervertebral discs of CT scans may be preferred for their ability to indicate signs of the disease more clearly than MRI.
MRI
MRI scans do not expose the patient to radiation and are highly sensitive to changes in the size and appearance of the intervertebral discs; however, findings on the MRI scan may be confused with other conditions such as the presence of tumors or bone fractures.
Other Imaging Findings
Additional tests may be ordered if such preliminary tests cannot confirm a diagnosis; for example, nuclear bone scans may be used to contrast areas of healthy bone with areas of infection.
Other Diagnostic Studies
Additional tests may be ordered if such preliminary tests cannot confirm a diagnosis; for example, needle biopsies may be needed to take samples of bone surrounding the disc space where the infection is thought to live.
References
- ↑ Carek, M.D., Peter (15). "Diagnosis and Management of Osteomyelitis". American Family Physician. 12 (63): 2413–2421. Retrieved March 27, 2012. Unknown parameter
|month=ignored (help); Unknown parameter|coauthors=ignored (help); Check date values in:|date=, |year= / |date= mismatch(help) - ↑ David Dugdale, III, M.D. (2010). A.D.A.M Medical Encyclopedia: Osteomyelitis. Bethesda, MD: United States National Library of Medicine. Retrieved 12 March 2012. Unknown parameter
|coauthors=ignored (help) - ↑ Wheeless, III, M.D., Clifford (2011). Wheeless' Textbook of Orthopaedics. Duke University: Duke University Medical Center.
- ↑ National Center for Biotechnology Information (2000). "Discitis versus Vertebral Osteomyelitis". Archives of Disease in Childhood. 4 (83): 368. PMC 1718514. PMID 10999882. Unknown parameter
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