European Spine Journal

, Volume 18, Supplement 1, pp 143–150 | Cite as

Evaluation of conservative treatment of non specific spondylodiscitis

  • N. Bettini
  • M. GirardoEmail author
  • E. Dema
  • S. Cervellati
Original Article


The objective of this study was to analyse the presentation, aetiology, conservative management, and outcome of non-tuberculous pyogenic spinal infection in adults. We performed a retrospective review of 56 patients (35 women and 21 men) of pyogenic spinal infection presenting over a 7-year period (1999–2006) to the Department of Spinal Surgery of Hesperia Hospital. The medical records, radiologic imaging, bacteriology results, treatment, and complications of all patients were reviewed. The mean age at presentation was 47.8 years (age range 35–72 years), the mean follow-up duration was 12.5 months. The most common site of infection was lumbar spine (n: 48), followed by the thoracic spine (n: 8). Most patients were symptomatic for between 4 and 10 weeks before presenting to hospital. The frequently isolated pathogen was Staphylococcus aureus in 31 of 56 cases (57.6%). Percutaneous biopsies were diagnostic in 57% of patients; the open biopsy was indicated if closed biopsy failed and when the infection was not accessible by percutaneous technique. The patients were managed by conservative measures alone, including antibiotic therapy and spinal bracing. The mean period of antibiotic therapy was 8.5 weeks (range 6–9 weeks), followed by oral antibiotics for 6 weeks. All patients had a supportive spinal brace for mean 8 weeks (range 6–10 weeks). The duration of the administration of oral antibiotics was dependent on clinical and laboratory evidence (white cell count, erythrocyte sedimentation rate, C-reactive protein) that the infection was resolved. The follow-up MR gadolinium scans were essential to monitor the response to medical treatment. The diagnosis of pyogenic spinal infection should be considered in any patient presenting with severe localised unremitting back and neck pain, especially when accompanied with systemic features, such as fever and weight loss and in the presence of elevated inflammatory markers. The conservative management of infection with antibiotic therapy and spinal bracing was very successful.


Open Biopsy Discitis Anatomic Segment Chronic Kidney Failure Pyogenic Spondylodiscitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest statement

None of the authors has any potential conflict of interest.


  1. 1.
    Acosta FL Jr, Chin CT, Quiñones-Hinojosa A, Ames CP, Weinstein PR, Chou D (2004) Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine. Neurosurg Focus 17:E2PubMedCrossRefGoogle Scholar
  2. 2.
    Acosta FL, Galvez LF, Ames C (2006) Recent advances: infections of the spine. Curr Infect Dis Rep 8:390–393PubMedCrossRefGoogle Scholar
  3. 3.
    An HS, Seldomridge JA (2006) Spinal infections: diagnostic tests and imaging studiesGoogle Scholar
  4. 4.
    Arnold PM, Baek PN, Bernardi RJ, Luck EA, Larson SJ (1997) Surgical management of nontuberculous thoracic and lumbar vertebral osteomyelitis: report of 33 cases. Surg Neurol 47:551–561PubMedCrossRefGoogle Scholar
  5. 5.
    Babu NV, Titus VT, Chittaranjan S, Abraham G, Prem H, Korula RJ (1994) Computed tomographically guided biopsy of the spine. Spine 19:2436–2442PubMedCrossRefGoogle Scholar
  6. 6.
    Belzunegui J, Del Val N, Intxausti JJ, De Dios JR, Queiro R, González C, Rodríguez-Valverde V, Figueroa M (1999) Vertebral osteomyelitis in northern Spain. Report of 62 cases. Clin Exp Rheumatol 17:447–452PubMedGoogle Scholar
  7. 7.
    Blake C, Codd MB, O’Meara YM (2000) The Short form 36 (SF-36) health survey: normative data for the Irish population. Ir J Med Sci 169:195–200PubMedCrossRefGoogle Scholar
  8. 8.
    Brugieres P, Revel MP, Dumas JL (1991) Ct-guided vertebral biopsy: a report of 89 cases. J Neuroradiol 18:351–359PubMedGoogle Scholar
  9. 9.
    Buranapanitkit B, Lim A, Geater A (2001) Misdiagnosis in vertebral osteomyelitis: problems and factors. J Med Assoc Thai 84:1743–1750PubMedGoogle Scholar
  10. 10.
    Buranapanitkit B, Lim A, Kiriratnikom T (2001) Clinical manifestation of tuberculous and pyogenic spine infection. J Med Assoc Thai 84:1522–1526PubMedGoogle Scholar
  11. 11.
    Butler JS, Shelly MJ, Timlin M, Powderly WG, O’Byrne JM (2006) Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center. Spine 31:2695–2700PubMedCrossRefGoogle Scholar
  12. 12.
    Cahill DW, Love LC, Rechtine GR (1991) Pyogenic osteomyelitis of the spine in the elderly. J Neurosurg 74:878–886PubMedCrossRefGoogle Scholar
  13. 13.
    Calderone RR, Larsen JM (1996) Overview and classification of spinal infections. Orthop Clin North Am 27:1–8PubMedGoogle Scholar
  14. 14.
    Carragee EJ (1997) Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am 79:874–880PubMedCrossRefGoogle Scholar
  15. 15.
    Chelsom J, Solberg CO (1998) Vertebral osteomyelitis at a Norwegian university hospital 1987–1997: clinical features, laboratory findings and outcome. Scand J Infect Dis 30:147–151PubMedCrossRefGoogle Scholar
  16. 16.
    Dagirmanjian A, Schils J, McHenry M, Modic MT (1996) MR imaging of vertebral osteomyelitis revisited. AJR Am J Roentgenol 67:1539–1543Google Scholar
  17. 17.
    Dagirmanjian A, Schils J, McHenry M (1999) MR imaging of spinal infections. Magn Reson Imaging Clin N Am 7:525–538PubMedGoogle Scholar
  18. 18.
    Digby JM, Kersley JB (1979) Pyogenic non-tuberculous spinal infection: an analysis of thirty cases. J Bone Joint Surg Br 61(1):47–55PubMedGoogle Scholar
  19. 19.
    Gasbarrini AL, Bertoldi E, Mazzetti M, Fini L, Terzi S, Gonella F, Mirabile L, Barbanti Bròdano G, Furno A, Gasbarrini A, Boriani S (2005) Clinical features, diagnostic and therapeutic approaches to haematogenous vertebral osteomyelitis. Eur Rev Med Pharmacol Sci 9:53–66PubMedGoogle Scholar
  20. 20.
    Govender S (2005) Spinal infections. J Bone Joint Surg Br 87:1454–1458PubMedCrossRefGoogle Scholar
  21. 21.
    Grollmus J, Perkins RK, Rusel W (1974) Erythrocyte sedimentation rate as a possible 16. Indicator of early disc space infection. Neurochirurgia (Stuttg) 17:30–35Google Scholar
  22. 22.
    Kallio MJ, Unkila-Kallio L, Aalto K, Peltola H (1997) Serum C-reactive protein, erythrocyte sedimentation rate and white blood cell count in septic arthritis in children. Pediatr Infect Dis 16:411–413CrossRefGoogle Scholar
  23. 23.
    Kapeller P, Fazekas F, Krametter D, Koch M, Roob G, Schmidt R, Offenbacher H (1997) Pyogenic infectious spondylitis: clinical, laboratory and MRI features. Eur Neurol 38:94–98PubMedCrossRefGoogle Scholar
  24. 24.
    Kornblum MB, Wesolowski DP, Fischgrund JS, Herkowitz HN (1998) Computed tomography-guided biopsy of the spine: a review of 103 patients. Spine 23:81–85PubMedCrossRefGoogle Scholar
  25. 25.
    Krogsgaard MR, Wagn P, Bengtsson J (1998) Epidemiology of acute vertebral osteomyelitis in Denmark: 137 cases in Denmark 1978–1982, compared to cases reported to the National Patient Register 1991–1993. Acta Orthop Scand 69:513–517PubMedGoogle Scholar
  26. 26.
    Ledermann HP, Schweitzer ME, Morrison WB, Carrino JA (2003) MR imaging findings in spinal infections: rules or myths? Radiology 228:506–514PubMedCrossRefGoogle Scholar
  27. 27.
    Lerner RK, Esterhai JL Jr, Polomono RC, Cheatle MC, Heppenstall RB, Brighton CT (1991) Psychosocial, functional, and quality of life assessment of patients with posttraumatic fracture nonunion, chronic refractory osteomyelitis, and lower extremity amputation. Arch Phys Med Rehabil 72:122–126PubMedGoogle Scholar
  28. 28.
    Mallya RK, de Beer FC, Berry H (1982) Correlation of clinical parameters of disease activity in rheumatoid arthritis with serum concentration of C-reactive protein and erythrocyte sedimentation rate. J Rheumatol 9:224–228PubMedGoogle Scholar
  29. 29.
    Mampalam TJ, Rosegay H, Andrews BT (1989) Nonoperative treatment of spinal epidural infections. J Neurosurg 71:208–210PubMedCrossRefGoogle Scholar
  30. 30.
    Matsui H, Hirano N, Sakaguchi Y (1998) Vertebral osteomyelitis: an analysis of 38 surgically treated cases. Eur Spine J 7:50–54PubMedCrossRefGoogle Scholar
  31. 31.
    Modic MT, Feiglin DH, Piraino DW, Boumphrey F, Weinstein MA, Duchesneau PM, Rehm S (1985) Vertebral osteomyelitis: assessment using MR. Radiology 157:157–166PubMedGoogle Scholar
  32. 32.
    Nolla JM, Ariza J, Gómez-Vaquero C, Fiter J, Bermejo J, Valverde J, Escofet DR, Gudiol F (2002) Spontaneous pyogenic vertebral osteomyelitis in nondrug users. Semin Arthritis Rheum 31:271–278PubMedCrossRefGoogle Scholar
  33. 33.
    Nussbaum ES, Rigamonti D, Standiford H (1992) Spinal epidural abscess: a report of 40 cases and review. Surg Neurol 38:225–231PubMedCrossRefGoogle Scholar
  34. 34.
    O’Daly BJ, Morris SF, O’Rourke SK (2008) Long-term functional outcome in pyogenic spinal infection. Spine 33:E246–E253PubMedCrossRefGoogle Scholar
  35. 35.
    Ogden AT, Kaiser MG (2004) Single-stage debridement and instrumentation for pyogenic spinal infections. Neurosurg Focus 17:E5PubMedCrossRefGoogle Scholar
  36. 36.
    Quinones-Hinojosa A, Jun P, Jacobs R, Rosenberg WS, Weinstein PR (2004) General principles in the medical and surgical management of spinal infections: a multidisciplinary approach. Neurosurg Focus 17:e1PubMedCrossRefGoogle Scholar
  37. 37.
    Redekop GJ, Del Maestro RF (1992) Diagnosis and management of spinal epidural abscess. Can J Neurol Sci 19:180–187PubMedGoogle Scholar
  38. 38.
    Rodiek SO (2001) Diagnostic methods in spinal infections. Radiology 41:976–986CrossRefGoogle Scholar
  39. 39.
    Ross PM, Fleming JL (1976) Vertebral body osteomyelitis: spectrum and natural history. A retrospective analysis of 37 cases. Clin Orthop Relat Res 118:190–198PubMedGoogle Scholar
  40. 40.
    Rothman SL (1996) The diagnosis of infections of the spine by modern imaging techniques. Orthop Clin North Am 27:111–123Google Scholar
  41. 41.
    Sapico FL, Montgomerie JZ (1979) Pyogenic vertebral osteomyelitis: report of nine cases and review of the literature. Rev Infect Dis 1:754–776PubMedGoogle Scholar
  42. 42.
    Sapico FL, Montgomerie JZ (1990) Vertebral osteomyelitis. Infect Dis Clin North Am 4:539–550PubMedGoogle Scholar
  43. 43.
    Sapico FL (1996) Microbiology and antimicrobial therapy of spinal infections. Orthop Clin North Am 27:9–13PubMedGoogle Scholar
  44. 44.
    Schimmer RC, Jeanneret C, Nunley PD, Jeanneret B (2002) Osteomyelitis of the cervical spine: a potentially dramatic disease. J Spinal Disord Tech 15:110–117PubMedGoogle Scholar
  45. 45.
    Siddiq F, Chowfin A, Tight R, Sahmoun AE, Smego RA Jr (2004) Medical vs surgical management of spinal epidural abscess. Arch Intern Med 164:2409–2412PubMedCrossRefGoogle Scholar
  46. 46.
    Slucky AV, Eismont FJ (1997) Spinal infections. In: Bridwell KH, De-Wald RL (eds) The textbook of spinal surgery, vol 2. Lippincott-Raven, Philadelphia, pp 2141–2183Google Scholar
  47. 47.
    Garcia Solis, del Pozo J, Soto MV, Solera J (2007) Vertebral osteomyelitis: long-term disability and prognostic factors. J Infect 54:129–134CrossRefGoogle Scholar
  48. 48.
    Still JM, Abranson R, Law EJ (1995) Development of an epidural abscess following staphylococcal septicaemia in an acutely burned patient: case report. J Trauma 38:158–159Google Scholar
  49. 49.
    Tali ET (2004) Spinal infections. Eur J Radiol 50:120–133PubMedCrossRefGoogle Scholar
  50. 50.
    Thelander U, Larsson S (1992) Quantitation of C-reactive protein levels and erythrocyte sedimentation rate after spinal surgery. Spine 17:400–404PubMedCrossRefGoogle Scholar
  51. 51.
    Tsiodras S, Falagas ME (2006) Clinical assessment and medical treatment of spine infections. Clin Orthop Relat Res 444:38–50PubMedCrossRefGoogle Scholar
  52. 52.
    Tyrell PNM, Cassar-Pollucino VN, McCall IW (1999) Spinal infection. Eur Radiol 9:1066–1077CrossRefGoogle Scholar
  53. 53.
    Varma R, Lander R, Assaf A (2001) Imaging of pyogenic infectious spondylodiscitis. Radiol Clin North Am 39:203–213PubMedCrossRefGoogle Scholar
  54. 54.
    Verner EF, Musher DM (1995) Spinal epidural abscess. Med Clin North Am 69:375–384Google Scholar
  55. 55.
    Vinas FC, King PK, Diaz FG (1999) Spinal aspergillus osteomyelitis. Clin Infect Dis 28:1223–1229PubMedCrossRefGoogle Scholar
  56. 56.
    Ware JE (1993) SF-36 health survey manual and interpretation guide. Nimrod Press, BostonGoogle Scholar
  57. 57.
    Weinberg J, Silber JS (2004) Infections of the spine: what the orthopaedist needs to know. Am J Orthop 33:13–17PubMedCrossRefGoogle Scholar
  58. 58.
    Whalen JL, Brown ML, McLeod R, Fitzgerald RH Jr (1991) Limitations of indium leukocyte imaging for the diagnosis of spine infections. Spine 16:193–197PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • N. Bettini
    • 1
  • M. Girardo
    • 2
    Email author
  • E. Dema
    • 1
  • S. Cervellati
    • 1
  1. 1.Scoliosis and Spine Surgery CenterHesperia HospitalModenaItaly
  2. 2.Department of Spine SurgeryC.T.O./C.R.F./Maria AdelaideTorinoItaly

Personalised recommendations