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| '''For patient information click [[Osteomyelitis (patient information)|here]]''' | | '''For patient information, click [[Osteomyelitis (patient information)|here]]''' |
| {{Vertebral osteomyelitis}} | | {{Vertebral osteomyelitis}} |
| {{CMG}} | | {{CMG}} |
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| {{SK}} Spinal osteomyelitis; disc space infection. | | {{SK}} Spinal osteomyelitis; disc space infection |
| ==Diagnosis== | | |
| Diagnosis of vertebral osteomyelitis is often complicated due to the delay between the onset of the disease and the initial display of symptoms. Before pursuing radiological methods of testing, physicians often order a full blood test to see how the patient's levels compare to normal blood levels in a healthy body.<ref name="US Library" /> In a complete blood test, the [[C-reactive protein]] (CRP) is an indicator of infection levels, the [[complete blood count]] (CBC) evaluates the presence of white and red blood cells, and the [[erythrocyte sedimentation rate]] (ESR) tests for inflammation in the body. Anomalous values that lie outside the acceptable ranges in any of these subcategories confirm the presence of infection in the body and indicate that further diagnostic measures are necessary. Blood tests may prove inconclusive and may not serve as enough evidence to confirm the presence of vertebral osteomyelitis. 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.<ref name="ADC: Discitis">{{cite journal|last=National Center for Biotechnology Information|title=Discitis versus Vertebral Osteomyelitis|journal=Archives of Disease in Childhood|year=2000|month=October|volume=4|issue=83|pages=368|accessdate=March 27, 2012|pmc=1718514|pmid=10999882}}</ref> Additional measures may be called upon to rule out the possibility of discitis; such approaches include diagnosing the disease through various medical imaging techniques.
| | ==[[Vertebral osteomyelitis overview|Overview]]== |
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| | ==[[Vertebral osteomyelitis historical perspective|Historical Perspective]]== |
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| | ==[[Vertebral osteomyelitis classification|Classification]]== |
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| | ==[[Vertebral osteomyelitis pathophysiology|Pathophysiology]]== |
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| | ==[[Vertebral osteomyelitis causes|Causes]]== |
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| | ==[[Vertebral osteomyelitis differential diagnosis|Differentiating Vertebral osteomyelitis from other Diseases]]== |
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| ===Radiological Diagnosis=== | | ==[[Vertebral osteomyelitis epidemiology and demographics|Epidemiology and Demographics]]== |
| 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. 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. 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. 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, or nuclear bone scans may be used to contrast areas of healthy bone with areas of infection.<ref name=miller />
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| ==Treatment== | | ==[[Vertebral osteomyelitis risk factors|Risk Factors]]== |
| Treatment options for vertebral osteomyelitis depend on the severity of the infection. Since the use of intravenous antibiotics seems to eliminate the responsible pathogen in most cases of vertebral osteomyelitis, physicians often attempt nonsurgical intervention before considering surgical options of treatment.<ref name="musher">{{cite journal|last=Musher, M.D.|first=Daniel|coauthors=Sigurdur Thorsteinsson, M.D. John Minuth, M.D. Robert Luchi, M.D.|title=Vertebral Osteomyelitis: Still a Diagnostic Pitfall|journal=Archives of Internal Medicine|year=1976|month=January|volume=136|issue=1|pages=105–110|url=http://archinte.ama-assn.org/cgi/content/abstract/136/1/105|accessdate=13 March 2012}}</ref>
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| ===Nonsurgical Intervention=== | | ==[[Vertebral osteomyelitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| Nonsurgical intervention is often desired because it poses less risk to the body of further infection that can occur if the body is unnecessarily exposed to other outside pathogens during surgery. Intravaneous antibiotics may be prescribed to kill the microorganism causing the infection. Such antibiotics are administered at a continuous rate for a varying amount of time, lasting from four weeks to several months. The outcome for patients who undergo intravaneous infusion differs according to factors such as age, strength of the immune system, and erthyrocyte sedimentation rate (ESR).<ref name="carragee">{{cite journal|last=Carragee, M.D.|first=Eugene|title=Pyogenic Vertebral Osteomyelitis|journal=The Journal of Bone and Joint Surgery|date=1|year=1997|month=June|volume=79|issue=6|pages=874–880|url=http://www.jbjs.org/article.aspx?Volume=79&page=874|accessdate=13 March 2012}}</ref> If intervention through antibiotics fails, patients are directed toward surgical treatment options.
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| ===Surgical Intervention=== | | ==Diagnosis== |
| Surgery may be required for patients with advanced cases of vertebral osteomyelitis. [[Spinal fusion]] is a common approach to destroying the microorganism causing the disease and rebuilding parts of the spine that were lost due to the infection. Fusions can be approached anteriorly or posteriorly, or both, depending on where the infection is located in the vertebral area. Spinal fusions involve cleaning the infected area of the spine and inserting instrumentation to stabilize the vertebrae and disc(s).<ref name=carragee /> Such instrumentation often includes bone grafts harvested from other areas of the body or from a bone bank, where bone fragments are harvested from deceased donors.<ref name="NIH Medline">{{cite web|title=Bone Graft|url=http://www.nlm.nih.gov/medlineplus/ency/article/002963.htm|publisher=National Institute of Health|accessdate=March 29, 2012}}</ref> The new bone graft is secured in the appropriate spinal region through the use of supporting rods and screws, most of which are made from titanium. Rods of this material promote healing and fusion of the bones more efficiently than stainless steel rods and are also more visible on MRI.<ref name=Bono>{{cite book|last=Bono|first=Christopher|title=Spine|year=2004|publisher=Lipincott, Williams, & Wilkins|pages=252|url=http://books.google.com/books?id=r3Zgl361w_cC&pg=PA252&lpg=PA252&dq=advantage+of+titanium+rods+spinal+fusion&source=bl&ots=2YxerByFhT&sig=hFuDM8TR92DiPCx2_5AbW0930WY&hl=en&sa=X&ei=vUR7T4--LIqQ9QSc6sWVBQ&ved=0CFwQ6AEwBQ#v=onepage&q=advantage%20of%20titanium%20rods%20spinal%20fusion&f=false}}</ref>
| | [[Vertebral osteomyelitis history and symptoms|History and Symptoms]] | [[Vertebral osteomyelitis physical examination|Physical Examination]] | [[Vertebral osteomyelitis laboratory findings|Laboratory Findings]] | [[Vertebral osteomyelitis x ray|X Ray]] | [[Vertebral osteomyelitis CT|CT]] | [[Vertebral osteomyelitis MRI|MRI]] | [[Vertebral osteomyelitis other imaging findings|Other Imaging Findings]] | [[Vertebral osteomyelitis other diagnostic studies|Other Diagnostic Studies]] |
| | ==Treatment== |
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| | [[Vertebral osteomyelitis medical therapy|Medical Therapy]] | [[Vertebral osteomyelitis surgery|Surgery]] | [[Vertebral osteomyelitis primary prevention|Primary Prevention]] | [[Vertebral osteomyelitis secondary prevention|Secondary Prevention]] | [[Vertebral osteomyelitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Vertebral osteomyelitis future or investigational therapies|Future or Investigational Therapies]] |
| | ==Case Studies== |
| | [[Vertebral osteomyelitis case study one|Case #1]] |
| ==Related Chapters== | | ==Related Chapters== |
| * [[Osteomyelitis]] | | * [[Osteomyelitis]] |
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| * [[Fine-needle aspiration]] | | * [[Fine-needle aspiration]] |
| * [[Intravenous therapy]] | | * [[Intravenous therapy]] |
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| ==References==
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| {{reflist}}
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| {{Osteochondropathy}} | | {{Osteochondropathy}} |
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| [[Category:Bacterial diseases]] | | [[Category:Bacterial diseases]] |
| [[Category:Skeletal disorders]] | | [[Category:Skeletal disorders]] |
| [[Category:Infectious disease]]
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| [[Category:Disease]] | | [[Category:Disease]] |
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |