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Risk factors and prognosis of vertebral compressive fracture in pyogenic vertebral osteomyelitis

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Abstract

Objectives

To analyse the clinical, microbiological and radiological characteristics, and to identify risk factors of vertebral compressive fracture (VF) in spontaneous pyogenic vertebral osteomyelitis (VO).

Methods

A retrospective clinical study and blinded radiological review of adult patients with VO.

Results

Eighty-eight patients were included: 57 (65 %) had a definitive diagnosis of VO (positive microbiology), and 31 (35 %) had a probable diagnosis of VO. Of these, 27 (30.7 %) presented with VF at diagnosis of VO, and 4 afterwards (total 31, 35.2 %). Patients with VF were considered to be at higher risk of osteopenia—they were older (74 vs 66 years, p = 0.013), and included high percentage of women (33 vs 41 %, NS)—; and presented more dorsal involvement (56 vs 21 %; p < 0.007). Causal microorganisms were similar between groups (VF, no VF). The time to diagnosis of VO was longer in the presence of VF (65 vs 23 days, p = 0.001), and also in cases with no isolated organisms. All patients received antibiotics, and just one patient required spinal stabilisation (VF). After 357 median days of follow-up, all patients were cured. Clinical improvement (residual pain, functional recovery) tended to be slower in patients with VF (log-rank 0.19 and 0.15, respectively), but clinical symptoms were similar in most patients at the last follow-up (VF, no VF).

Conclusions

VF is a common complication in pyogenic VO that causes slower clinical recovery. Risk factors of VF are: osteopenia, a delayed diagnosis and dorsal involvement. Conservative management is probably appropriate for most cases, but spinal stabilisation should be considered in some specific cases.

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Acknowledgment

We thank Michael Maudsley for revising the English manuscript. A. R. was supported by a research grant from the Bellvitge Biomedical Research Institute (IDIBELL).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L’Hospitalet de LLobregat, Barcelona, Spain

    Alba Ribera, Maria Labori, Jaime Lora-Tamayo, Javier Ariza & Oscar Murillo

  2. Radiology Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain

    Javier Hernández & José A. Narváez

  3. Orthopaedic Surgery Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain

    Lluís González-Cañas & Federic Font

  4. Rheumatology Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain

    Joan M. Nolla

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  1. Alba Ribera
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  2. Maria Labori
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  3. Javier Hernández
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  4. Jaime Lora-Tamayo
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  6. Federic Font
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  7. Joan M. Nolla
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Correspondence to Alba Ribera.

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Ribera, A., Labori, M., Hernández, J. et al. Risk factors and prognosis of vertebral compressive fracture in pyogenic vertebral osteomyelitis. Infection 44, 29–37 (2016). https://doi.org/10.1007/s15010-015-0800-z

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  • DOI: https://doi.org/10.1007/s15010-015-0800-z

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