Vertebral osteomyelitis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Spinal osteomyelitis; disc space infection.
Overview
Historical Perspective
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.[1] 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.[2] Additional measures may be called upon to rule out the possibility of discitis; such approaches include diagnosing the disease through various medical imaging techniques.
Radiological Diagnosis
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.[3]