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Vertebral osteomyelitis: eight years’ experience of 100 cases

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Abstract

To evaluate the etiology and characteristics of vertebral osteomyelitis cases in our country, patients with vertebral osteomyelitis between January 2000 and December 2007 were included in this study. Clinical and laboratory data of the patients were collected from the medical records retrospectively. Of these 100 patients, 44 had pyogenic, 24 had brucellar, and 32 had tuberculous spondylodiscitis. The age of the patients ranged from 13 to 82 years, with a mean of (SD±) 55 ± 15.6 years. Within the pyogenic group, 10 (22.7%) patients had a spinal surgery history, and in 18 patients of the pyogenic group, an etiological agent was isolated. Ten (56%) of these 18 were methicillin-sensitive Staphylococcus aureus. While all of the patients included in this study suffered from pain, 49 of these had fever. Sixty-nine percent of the patients had lumbar involvement. The etiological distribution may differ according to geographical areas. Although brucella and tuberculosis (TB) are endemic in our country, pyogenic vertebral osteomyelitis was more frequent. The most common involved area in our patients was the lumbar vertebrae. Although thoracic involvement may be more predominant in tuberculous vertebral osteomyelitis, it does not strongly suggest TB. Magnetic resonance imaging may exclude some disorders mimicking vertebral osteomyelitis and may delineate the degree of the involvement. Microbiological and/or histopathological examination of computerized tomography-guided fine-needle aspiration biopsies are the mainstays for the diagnosis. Suspicion and early diagnosis seem critical for preventing sequelae development.

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References

  1. Berbari EF, Steckelberg JM, Osmon DR (2005) Osteomyelitis. In: Mandell GL, Bennett JE, Dolin R (eds) Principles and practice of infectious diseases, vol 1, 6th edn. Churchill Livingstone, Philadelphia, pp 1322–1332

    Google Scholar 

  2. Currier BL, Eismont FJ (1992) Infections of the spine. In: Rothman RHü Simeone FA (eds) The Spine, 3rd edn, vol 2. W.B Saunders Company, Philadelphia, pp 1319–1380

  3. Mylona E, Samarkos M, Kakalou E, Fanourgiakis F, Skoutelis A (2009) Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Sem Arthritis Rheum 39:10–17

    Article  CAS  Google Scholar 

  4. Jaramillo-de la Torre JJ, Bohinski RJ, Kuntz C (2006) Vertebral osteomyelitis. Neurosurg Clin N Am 17:339–351

    Article  PubMed  Google Scholar 

  5. Zimmerli W (2010) Vertebral osteomyelitis. N Engl J Med 362:1022–1029

    Article  PubMed  CAS  Google Scholar 

  6. Jensen AG, Espersen F, Skinhoj P, Frimodt-Moeller N (1998) Bacteremic Staphylococcus aureus spondylitis. Arch Intern Med 158:509–517

    Article  PubMed  CAS  Google Scholar 

  7. Pirest DH, Peacock JE (2005) Hematogenous vertebral osteomyelitis due to Staphylococcus aureus in the adult: clinical features and therapeutic outcomes. South Med J 98:854–862

    Article  Google Scholar 

  8. Mc Henry MC, Easley KA, Locker GA (2002) Vertebral osteomyelitis: Long-term outcome for 253 patients from 7 Cleveland-area hospitals. CID 34:1342–1350

    Article  Google Scholar 

  9. Lew DP, Waldvogel FA (2004) Osteomyelitis. Lancet 364:369–379

    Article  PubMed  CAS  Google Scholar 

  10. Modic MT, Feiglin DH, Piraino DW, Boumphrey F, Weinstein MA, Duchesneau PM (1985) Vertebral osteomyelitis: assessment using MR. Radiol 157:157–166

    CAS  Google Scholar 

  11. Colmenero JD, Jiménez-Mejias ME, Sánchez-Lora FJ, Reguera JM, Palomino Nicas J, Martos F et al (1997) Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases. Ann Rheum Dis 56:709–715

    Article  PubMed  CAS  Google Scholar 

  12. Therese KL, Jayanathi U, Madhavan HN (2005) Application of nested polymerase chain reaction (nPCR) using MPB 64 gene primers to detect Mycobacterium tuberculosis DNA in clinical specimens from extrapulmonary tuberculosis patients. Indian J Med Res 122:165–170

    PubMed  CAS  Google Scholar 

  13. Lucio E, Adesokan A, Hadjipavlou AG, Crow NW, Adegboyega PA (2000) Pyogenic Spondylodiskitis. Arch Pathol Lab Med 124:712–716

    PubMed  CAS  Google Scholar 

  14. Weisz RD, Errico TJ (2000) Spinal infections diagnosis and treatment. Bull Hosp Joint Dis 59:40–46

    CAS  Google Scholar 

  15. Tsiodras S, Falagas ME (2006) Clinical assessment and medical treatment of spinal infections. Clin Orthop Relat Res 444:38–50

    Article  PubMed  Google Scholar 

  16. Burananapanitkit B, Lim A, Greater A (2001) Misdiagnosis in vertebral osteomyelitis: problems and factors. J Med Assoc Thai 84:1743–1750

    Google Scholar 

  17. Colmenero JD, Jiménez-Mejias ME, Reguera JM, Palomino-Nicas J, Ruiz-Mesa JD, Marquez-Rivas J et al (2004) Tuberculous vertebral osteomyelitis in the new millennium: still a diagnostic and therapeutic challenge. Eur J Clin Microbiol Infect Dis 23:477–483

    Article  PubMed  CAS  Google Scholar 

  18. Buchelt M, Lack W, Kutschera HP, Katterschafka T, Kiss H, Schneider B et al. (1993) Comparison of tuberculous and pyogenic spondylitis. An analysis of 122 cases. Clin Orthop Relat Res 296:192–199

    Google Scholar 

  19. Concia E, Prandini N, Massari L, Ghisellini F, Consoli V, Menichetti F et al (2006) Osteomyelitis: clinical update for practical guidelines. Nucl Med Commun 27:645–660

    Article  PubMed  Google Scholar 

  20. Gasbarrini AL, Bertoldi E, Mazzetti M, Fini L, Terzi S, Gonella F et al (2005) Clinical features, diagnostic and therapeutic approaches to haematogenous vertebral osteomyelitis. Eur Rev Med Pharmacol Sci 9:53–66

    PubMed  CAS  Google Scholar 

  21. Moromizato T, Harano K, Oyakawa M, Tokuda Y (2006) Diagnostic performance of pyogenic vertebral osteomyelitis. Intern Med 46:11–16

    Google Scholar 

  22. Corpataux J, Halkic N, Wettstein M, Dusmet M (2000) The role of laparoscopic biopsies in lumbar spondylodiscitis. Surg Laparosc Endosc Percutan Tech 10:417–419

    PubMed  CAS  Google Scholar 

  23. Mann S, Schütze M, Sola M, Piek J (2004) Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients. Neurosurg Focus 17:1–7

    Article  Google Scholar 

  24. Hadjipavlou AG, Mader JT, Necessary JT, Muffoletto AJ (2000) Hematogenous pyogenic spinal infections and their surgical management. Spine 25:1679–1688

    Google Scholar 

  25. Acharya S, Bhatnagar P (2004) Salmonella spinal osteomyelitis: a case report and review of the literature. Neurol India 52:499–500

    PubMed  Google Scholar 

  26. Cha J, Hong H, Koh Y, Kim H, Park J (2008) Candida albicans osteomyelitis of the cervical spine. Skeletal Radiol 37:347–350

    Article  PubMed  Google Scholar 

  27. Torres-Ramos FM, Botwin KP, Shah CP (2004) Candida spondylodiscitis: an unusual case of thoracolumbar pain with review of imaging findings and description of the clinical condition. Pain Physician 7:257–260

    PubMed  Google Scholar 

  28. D’Antonio D, Piccolomini R, Fioritoni G, Iacone A, Betti S, Fazii P et al (1994) Osteomyelitis and intervertebral discitis caused by Blastoschizomyces capitatus in a patient with acute leukemia. J Clin Microbiol 32:224–227

    PubMed  Google Scholar 

  29. Celik AD, Ozaras R, Kantarcıoglu S, Mert A, Tabak F, Ozturk R (2009) Spondylodiscitis due to an emergent fungal pathogen: Blastoschizomyces capitatus, a case report and review of the literature. Rheumatol Int 29:1237–1241

    Article  PubMed  Google Scholar 

  30. Pigrau C, Almirante B, Flores X, Falco V, Rodriguez D, Gasser I et al (2005) Spontaneous pyogenic vertebral osteomyelitis and endocarditis: incidence, risk factors and outcome. Am J Med 118:e17–e24

    Article  Google Scholar 

  31. Galpérine T, Ader F, Judet T, Peronne C, Bernard L (2006) Outpatient parenteral antimicrobial therapy (OPAT) in bone and joint infections. Med Mal Infect 36:132–137

    Article  PubMed  Google Scholar 

  32. Colmenero JD, Ruiz-Mesa JD, Plata A, Bermudez P, Martin-Rico P, Queipo-Ortuno MI et al (2008) Clinical findings, therapeutic approach, and outcome of brucellar vertebral osteomyelitis. Clin Infect Dis 46:426–433

    Article  PubMed  Google Scholar 

  33. Al Soub H, Uwaydah AK, Hussain AH (1994) Vertebral osteomyelitis in Qatar. Br J Cln Pract 48:130–132

    CAS  Google Scholar 

  34. Calvo JM, Ramos JL, Garcia F, Bureo JC, Bureo P, Pérez M (2000) Pyogenic and non-pyogenic vertebral osteomyelitis: descriptive and comparative study of a series of 40 cases. Enferm Infecc Microbiol Clin 18:452–456

    PubMed  CAS  Google Scholar 

  35. Ariza J, Gudiol F, Valverde J, Pallares R, Fernandez-Viladrich P, Rufi G (1985) Brucellar spondylitis: a detailed analysis based on current findings. Rev Infect Dis 7:656–664

    Article  PubMed  CAS  Google Scholar 

  36. Tekkök IH, Berker M, Özcan OE, Özgen T, Akalın E (1993) Brucellosis of the spine. Neurosurgery 33:838–844

    Article  PubMed  Google Scholar 

  37. Solera J, Lozano E, Martinez-Alfaro E, Espinosa A, Castillejos ML, Abad L (1999) Brucellar spondylitis:review of 35 cases and literature survey. Clin Infect Dis 29:1440–1449

    Article  PubMed  CAS  Google Scholar 

  38. Belzunegui J, Del Val N, Intxausti JJ, De Dios JR, Queiro R, Gonzalez C (1999) Vertebral osteomyelitis in northern Spain. Report of 62 cases. Clin Exp Rheumatol 17:447–452

    Google Scholar 

  39. Schlesinger N, Lardizabal A, Rao J, Rao J, Mc Donald R (2005) Tuberculosis of the Spine experience in an inner city hospital. J Clin Rheumatol 11:17–20

    Article  PubMed  Google Scholar 

  40. Cotten A, Flipo RM, Drouot MH, Maury F, Chastenet P, Duquesnoy B et al. (1996) La tuberculose vertébrale. Étude des aspects cliniques et adiologiques à partir d’une série de 82 cas. J Radiol 77:419–426

    Google Scholar 

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Authors and Affiliations

  1. Cerrahpasa Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Istanbul University, Kocamustafa Paşa, 34098, Istanbul, Turkey

    Bilgul Mete, Celali Kurt, Resat Ozaras, Ali Mert, Fehmi Tabak & Recep Ozturk

  2. Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University, Istanbul, Turkey

    Mehmet Halit Yilmaz & Gulhan Ertan

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  1. Bilgul Mete
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  2. Celali Kurt
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  3. Mehmet Halit Yilmaz
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Correspondence to Bilgul Mete.

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Mete, B., Kurt, C., Yilmaz, M.H. et al. Vertebral osteomyelitis: eight years’ experience of 100 cases. Rheumatol Int 32, 3591–3597 (2012). https://doi.org/10.1007/s00296-011-2233-z

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  • DOI: https://doi.org/10.1007/s00296-011-2233-z

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