Vertebral osteomyelitis

Mechanism and manifestations

Persistent pain may predominate, with or without fever. Bacteremia, immunosuppression or a recent procedure may raise suspicion. Absence of fever does not exclude infection.

Diagnosis and management

MRI, inflammatory markers, blood cultures and sometimes biopsy investigate the focus and organism. Antibiotics are tailored to findings; drainage or stabilization may be needed. Neurological deficit or sepsis requires urgent care. TAGMED modalities do not treat this infection.

Points to consider

Infection and inflammatory disease require different treatments. Fever, immunosuppression, infection history, unusual pain and neurological deficits influence urgency. Absence of fever does not exclude infection. Physical modalities must not delay necessary medical investigation.

Role of TAGMED care

With acute symptoms, urgent hospital assessment takes priority. This condition first requires medical diagnosis and, depending on the situation, specialist management. TAGMED services do not replace treatment of infection or tumor, stabilization of an unstable injury, or neurological or vascular treatment. Any conservative support should be considered only after diagnosis, restrictions and the treating team’s recommendations have been clarified.

Related concepts and distinctions

These concepts belong to the same field, but are not synonyms.

• Spinal tuberculosis — Spinal infection caused by Mycobacterium tuberculosis, potentially destroying vertebrae and causing abscess, deformity or neurological compression.
• Septic facet joint arthritis — Infection of a vertebral facet joint that may spread into paraspinal tissues or the epidural space.
• Cervical involvement in rheumatoid arthritis — Inflammatory cervical joint and ligament involvement in rheumatoid arthritis, potentially causing atlantoaxial instability among other changes.

Medical references

1. Infectious Diseases Society of America. Native Vertebral Osteomyelitis in Adults: Clinical Practice Guidelines.
2. American College of Radiology / RSNA, RadiologyInfo. Spine MRI.

References document the topic; their inclusion does not imply endorsement of TAGMED services by those organizations.