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Diagnosing and treating native spinal and pelvic osteomyelitis in adolescents

  • Case Series
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Abstract

Study design

Retrospective case series.

Objectives

To describe how pediatric patients with spinal and pelvic osteomyelitis are diagnosed and treated and assess the diagnostic value of magnetic resonance imaging (MRI), needle aspiration biopsy (NAB), and blood cultures in this population.

Summary of background data

Spinal and pelvic osteomyelitis de novo are uncommon in children and minimal literature exists on the subject. Research has shown that NAB and blood cultures have variable diagnostic yield in adult native osteomyelitis. At our institution, there is no standard protocol for diagnosing and treating pediatric spinal and pelvic osteomyelitis de novo.

Methods

All diagnoses of spinal and pelvic osteomyelitis at a pediatric tertiary care center from 2003 to 2017 were reviewed. Patients aged 0–21 at diagnosis were included. Patients with osteomyelitis resulting from prior spinal operations, wounds, or infections and those with chronic recurrent multifocal osteomyelitis were eliminated. All eligible patients’ diagnoses were confirmed by MRI.

Results

29 patients (18 men, 11 women) met the inclusion criteria. The median age at diagnosis was 11 years old (range 1–18). More than half of all cases (17/29, 59%) affected the lumbar spine. The most common symptoms were back pain (20/29, 69%), fever (18/29, 62%), hip pain (11/29, 38%), and leg pain (8/29, 28%). The majority of NABs and blood cultures performed were negative, but of the positive tests Staphylococcus aureus was the most prevalent bacteria. 86% (25/29) had an MRI before a diagnosis was made and 72% (13/18) had an NAB performed post-diagnosis.

Conclusions

MRI is a popular and helpful tool in diagnosing spinal osteomyelitis de novo. NAB cultures are often negative but can be useful in determining antibiotic treatment.

Level of evidence

Level IV.

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Funding

No funding was received for this work.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Boston Children’s Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA

    Lara L. Cohen, Benjamin J. Shore, Kathryn A. Williams, Daniel J. Hedequist, M. Timothy Hresko, John B. Emans, Lawrence I. Karlin, Brian D. Snyder & Michael P. Glotzbecker

  2. Harvard Medical School, Boston, MA, USA

    Benjamin J. Shore, Daniel J. Hedequist, M. Timothy Hresko, John B. Emans, Lawrence I. Karlin, Brian D. Snyder & Michael P. Glotzbecker

Authors
  1. Lara L. Cohen
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  2. Benjamin J. Shore
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  3. Kathryn A. Williams
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  4. Daniel J. Hedequist
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  5. M. Timothy Hresko
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  6. John B. Emans
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  7. Lawrence I. Karlin
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  8. Brian D. Snyder
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  9. Michael P. Glotzbecker
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Contributions

LLC: data collection, analysis, investigation, methodology, writing- original manuscript, writing- reviewing and editing, final approval. BJS: conceptualization, visualization, writing-reviewing and editing, final approval. KAW: analysis, methodology, writing- original manuscript, final approval. DJH: data acquisition, writing-reviewing and editing, final approval. MTH: data acquisition, writing- reviewing and editing, final approval. JBE: Data acquisition, writing- reviewing and editing, final approval. LIK: data acquisition, writing- reviewing and editing, final approval. BDS: data acquisition, writing- reviewing and editing, final approval. MPG: conceptualization, investigation, methodology, project administration, resources, supervision, visualization, data acquisition, writing- reviewing and editing, final approval.

Corresponding author

Correspondence to Michael P. Glotzbecker.

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No conflicts of interest or source of funding to declare.

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IRB approved by Boston Children’s Hospital.

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Cohen, L.L., Shore, B.J., Williams, K.A. et al. Diagnosing and treating native spinal and pelvic osteomyelitis in adolescents. Spine Deform 8, 1001–1008 (2020). https://doi.org/10.1007/s43390-020-00110-8

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  • DOI: https://doi.org/10.1007/s43390-020-00110-8

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