eMedicine Specialties > Orthopedic Surgery > Spine

Spinal Infections: Follow-up

Author: Federico C Vinas, MD, Consulting Neurosurgeon, Department of Neurological Surgery, Halifax Medical Center
Coauthor(s): J Richard Rhodes, MD, Orthopedic Surgeon, Atlantic Orthopaedics, PA, and Coastal Medical Research; Amy L Stumpf, MPH, PA-C, Clinical Director, Assistant Professor, Physician Assistant Program, Nova Southeastern University
Contributor Information and Disclosures

Updated: Nov 3, 2008

Outcome and Prognosis

Both bony and neural status must be considered in the evaluation of treatment outcome. Most patients can be cured by a treatment protocol that includes antibiotics alone or in combination with surgery.29,30 For patients with an incomplete neurologic compromise, several studies indicate that with aggressive antibiotic and surgical therapy, paresis may improve or resolve.31,32,33 Only 15% of patients experience permanent neurologic deficits. Recrudescence of infection occurs in 2-8% of patients.

Future and Controversies

In the future, the introduction of newer, more effective antibiotics may contribute to the treatment of these infections. For patients requiring a fusion, the use of growth factors for the induction of spinal fusions is a theoretically attractive approach. Numerous studies have shown that viral vectors can be used to implant osteoinductive growth factor genes directly into the paraspinal muscles or into cells that can subsequently be implanted next to the spine. These osteoinductive factors enhance the activation and differentiation of pluripotent stem cells to develop into mature bone.

 


More on Spinal Infections

Overview: Spinal Infections
Workup: Spinal Infections
Treatment: Spinal Infections
Follow-up: Spinal Infections
Multimedia: Spinal Infections
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Schimmer RC, Jeanneret C, Nunley PD. Osteomyelitis of the cervical spine: a potentially dramatic disease. J Spinal Disord Tech. Apr 2002;15(2):110-7. [Medline].

  2. Ziai WC, Lewin JJ 3rd. Update in the diagnosis and management of central nervous system infections. Neurol Clin. May 2008;26(2):427-68. [Medline].

  3. Kourbeti IS, Tsiodras S, Boumpas DT. Spinal infections: evolving concepts. Curr Opin Rheumatol. Jul 2008;20(4):471-9. [Medline].

  4. An HS, Seldomridge JA. Spinal infections: diagnostic tests and imaging studies. Clin Orthop Relat Res. Mar 2006;444:27-33. [Medline].

  5. Mylona E, Samarkos M, Kakalou E, Fanourgiakis P, Skoutelis A. Pyogenic Vertebral Osteomyelitis: A Systematic Review of Clinical Characteristics. Semin Arthritis Rheum. Jun 10 2008;[Medline].

  6. Jaramillo-de la Torre JJ, Bohinski RJ, Kuntz C 4th. Vertebral osteomyelitis. Neurosurg Clin N Am. Jul 2006;17(3):339-51, vii. [Medline].

  7. Fernandez M, Carrol CL, Baker CJ. Discitis and vertebral osteomyelitis in children: an 18-year review. Pediatrics. Jun 2000;105(6):1299-304. [Medline].

  8. Lee KC, Tsai YT, Lin CY. Vertebral osteomyelitis combined streptococcal viridans endocarditis. Eur J Cardiothorac Surg. Jan 2003;23(1):125-7. [Medline].

  9. Martínez Hernández PL, Amer López M, Zamora Vargas F, García de Paso P, Navarro San Francisco C, Pérez Fernández E, et al. [Spontaneous Infectious Spondylodiscitis in an Internal Medicine Department: epidemiological and clinical study in 41 cases.]. Rev Clin Esp. Jul 2008;208(7):347-52. [Medline].

  10. Cahill DW, Love LC, Rechtine GR. Pyogenic osteomyelitis of the spine in the elderly. J Neurosurg. Jun 1991;74(6):878-86. [Medline].

  11. Gotway MB, Marder SR, Hanks DK. Thoracic complications of illicit drug use: an organ system approach. Radiographics. Oct 2002;22 Spec No:S119-35. [Medline].

  12. Toyota T. Vertebral osteomyelitis in diabetes mellitus. Intern Med. Jun 1997;36(6):382-3. [Medline].

  13. Hadjipavlou AG, Mader JT, Necessary JT. Hematogenous pyogenic spinal infections and their surgical management. Spine. Jul 1 2000;25(13):1668-79. [Medline].

  14. Colmenero JD, Jimenez-Mejias ME, Sanchez-Lora FJ. Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases. Ann Rheum Dis. Dec 1997;56(12):709-15. [Medline].

  15. Miller DJ, Mejicano GC. Vertebral osteomyelitis due to Candida species: case report and literature review. Clin Infect Dis. Aug 15 2001;33(4):523-30. [Medline].

  16. Nussbaum ES, Rockswold GL, Bergman TA. Spinal tuberculosis: a diagnostic and management challenge. J Neurosurg. Aug 1995;83(2):243-7. [Medline].

  17. Vinas FC, King PK, Diaz FG. Spinal aspergillus osteomyelitis. Clin Infect Dis. Jun 1999;28(6):1223-9. [Medline].

  18. Wang YC, Lee ST. Candida vertebral osteomyelitis: a case report and review of the literature. Chang Gung Med J. Dec 2001;24(12):810-5. [Medline].

  19. Milstone AM, Maragakis LL, Townsend T, Speck K, Sponseller P, Song X, et al. Timing of Preoperative Antibiotic Prophylaxis: A Modifiable Risk Factor for Deep Surgical Site Infections After Pediatric Spinal Fusion. Pediatr Infect Dis J. Jun 19 2008;[Medline].

  20. Sasso RC, Garrido BJ. Postoperative spinal wound infections. J Am Acad Orthop Surg. Jun 2008;16(6):330-7. [Medline].

  21. Fujiyoshi T, Goto K, Shiomori T. [A case of spinal epidural abscess associated with retropharyngeal abscess]. Nippon Jibiinkoka Gakkai Kaiho. Nov 2002;105(11):1143-6. [Medline].

  22. Buranapanitkit B, Lim A, Kiriratnikom T. Clinical manifestation of tuberculous and pyogenic spine infection. J Med Assoc Thai. Nov 2001;84(11):1522-6. [Medline].

  23. Carragee EJ. The clinical use of magnetic resonance imaging in pyogenic vertebral osteomyelitis. Spine. Apr 1 1997;22(7):780-5. [Medline].

  24. Nolla JM, Ariza J, Gomez-Vaquero C. Spontaneous pyogenic vertebral osteomyelitis in nondrug users. Semin Arthritis Rheum. Feb 2002;31(4):271-8. [Medline].

  25. Jordan MC, Kirby WM. Pyogenic vertebral osteomyelitis. Treatment with antimicrobial agents and bed rest. Arch Intern Med. Sep 1971;128(3):405-10. [Medline].

  26. Carragee EJ, Kim D, van der Vlugt T. The clinical use of erythrocyte sedimentation rate in pyogenic vertebral osteomyelitis. Spine. Sep 15 1997;22(18):2089-93. [Medline].

  27. Safran O, Rand N, Kaplan L. Sequential or simultaneous, same-day anterior decompression and posterior stabilization in the management of vertebral osteomyelitis of the lumbar spine. Spine. Sep 1 1998;23(17):1885-90. [Medline].

  28. Dai LY, Chen WH, Jiang LS. Anterior instrumentation for the treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine. Eur Spine J. Jun 25 2008;[Medline].

  29. Matsui H, Hirano N, Sakaguchi Y. Vertebral osteomyelitis: an analysis of 38 surgically treated cases. Eur Spine J. 1998;7(1):50-4. [Medline].

  30. McHenry MC, Easley KA, Locker GA. Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis. May 15 2002;34(10):1342-50. [Medline].

  31. Arnold PM, Baek PN, Bernardi RJ. Surgical management of nontuberculous thoracic and lumbar vertebral osteomyelitis: report of 33 cases. Surg Neurol. Jun 1997;47(6):551-61. [Medline].

  32. Gepstein R, Folman Y, Lidor C. Management of pyogenic vertebral osteomyelitis with spinal cord compression in the elderly. Paraplegia. Nov 1992;30(11):795-8. [Medline].

  33. Rath SA, Neff U, Schneider O. Neurosurgical management of thoracic and lumbar vertebral osteomyelitis and discitis in adults: a review of 43 consecutive surgically treated patients. Neurosurgery. May 1996;38(5):926-33. [Medline].

  34. Hee HT, Majd ME, Holt RT. Better treatment of vertebral osteomyelitis using posterior stabilization and titanium mesh cages. J Spinal Disord Tech. Apr 2002;15(2):149-56; discussion 156. [Medline].

  35. Ploumis A, Mehbod AA, Dressel TD, Dykes DC, Transfeldt EE, Lonstein JE. Therapy of Spinal Wound Infections Using Vacuum-assisted Wound Closure: Risk Factors Leading to Resistance to Treatment. J Spinal Disord Tech. Jul 2008;21(5):320-3. [Medline].

  36. Graziano GP, Sidhu KS. Salvage reconstruction in acute and late sequelae from pyogenic thoracolumbar infection. J Spinal Disord. Jun 1993;6(3):199-207. [Medline].

  37. Ambrose GB, Alpert M, Neer CS. Vertebral osteomyelitis. A diagnostic problem. JAMA. Aug 22 1966;197(8):619-22. [Medline].

  38. Boussel L, Marchand B, Blineau N. [Imaging of osteoarticular tuberculosis]. J Radiol. Sep 2002;83(9 Pt 1):1025-34. [Medline].

  39. Buranapanitkit B, Lim A, Geater A. Misdiagnosis in vertebral osteomyelitis: problems and factors. J Med Assoc Thai. Dec 2001;84(12):1743-50. [Medline].

  40. Del Santo M, Malorgio C, Not T. Vertebral osteomyelitis in 2 children. Clin Pediatr (Phila). Nov-Dec 2002;41(9):711-3. [Medline].

  41. Djurasovic M, Glassman SD, Dimar JR 2nd. Vertebral osteonecrosis associated with the use of intradiscal electrothermal therapy: a case report. Spine. Jul 1 2002;27(13):E325-8. [Medline].

  42. Ehara S, Khurana JS, Kattapuram SV. Pyogenic vertebral osteomyelitis of the posterior elements. Skeletal Radiol. 1989;18(3):175-8. [Medline].

  43. Heary RF, Hunt CD, Wolansky LJ. Rapid bony destruction with pyogenic vertebral osteomyelitis. Surg Neurol. Jan 1994;41(1):34-9. [Medline].

  44. Hidalgo-Ovejero AM, Otermin I, Garcia-Mata S. Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am. May 1998;80(5):764. [Medline].

  45. Isobe Z, Utsugi T, Ohyama Y. Recurrent pyogenic vertebral osteomyelitis associated with type 2 diabetes mellitus. J Int Med Res. Sep-Oct 2001;29(5):445-50. [Medline].

  46. Jain R, Sawhney S, Berry M. Computed tomography of vertebral tuberculosis: patterns of bone destruction. Clin Radiol. Mar 1993;47(3):196-9. [Medline].

  47. Kao PF, Tsui KH, Leu HS. Diagnosis and treatment of pyogenic psoas abscess in diabetic patients: usefulness of computed tomography and gallium-67 scanning. Urology. Feb 2001;57(2):246-51. [Medline].

  48. Khan IA, Vaccaro AR, Zlotolow DA. Management of vertebral diskitis and osteomyelitis. Orthopedics. Aug 1999;22(8):758-65. [Medline].

  49. King DM, Mayo KM. Infective lesions of the vertebral column. Clin Orthop. Oct 1973;96:248-53. [Medline].

  50. Klein JD, Hey LA, Yu CS. Perioperative nutrition and postoperative complications in patients undergoing spinal surgery. Spine. Nov 15 1996;21(22):2676-82. [Medline].

  51. Phadke DM, Lucas DR, Madan S. Fine-needle aspiration biopsy of vertebral and intervertebral disc lesions: specimen adequacy, diagnostic utility, and pitfalls. Arch Pathol Lab Med. Nov 2001;125(11):1463-8. [Medline].

  52. Przybylski GJ, Sharan AD. Single-stage autogenous bone grafting and internal fixation in the surgical management of pyogenic discitis and vertebral osteomyelitis. J Neurosurg. Jan 2001;94(1 Suppl):1-7. [Medline].

  53. Rasool MN. Primary subacute haematogenous osteomyelitis in children. J Bone Joint Surg Br. Jan 2001;83(1):93-8. [Medline].

  54. Schilling F, Fedlmeier M, Eckardt A. [Vertebral manifestation of chronic recurrent multifocal osteomyelitis (CRMO)]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. Oct 2002;174(10):1236-42. [Medline].

  55. Sexton DJ, Spelman D. Current best practices and guidelines. Assessment and management of complications in infective endocarditis. Infect Dis Clin North Am. Jun 2002;16(2):507-21, xii. [Medline].

  56. Shih TT, Huang KM, Hou SM. Early diagnosis of single segment vertebral osteomyelitis--MR pattern and its characteristics. Clin Imaging. May-Jun 1999;23(3):159-67. [Medline].

  57. Stauffer RN. Pyogenic vertebral osteomyelitis. Orthop Clin North Am. Oct 1975;6(4):1015-27. [Medline].

  58. Stephens JC, Artz SW, Ames BN. Guanosine 5'-diphosphate 3'-diphosphate (ppGpp): positive effector for histidine operon transcription and general signal for amino-acid deficiency. Proc Natl Acad Sci U S A. Nov 1975;72(11):4389-93. [Medline].

  59. Turpin S, Lambert R. Role of scintigraphy in musculoskeletal and spinal infections. Radiol Clin North Am. Mar 2001;39(2):169-89. [Medline].

[ CLOSE WINDOW ]

Further Reading

Procedure guideline for 111in-leukocyte scintigraphy for suspected infection/inflammation.
Society of Nuclear Medicine.  1999 Feb (revised 2004 Jun 2).  6 pages.  NGC:004261
 
Procedure guideline for 99m Tc-Exametazime (HMPAO)-labeled leukocyte scintigraphy for suspected infection/inflammation.
Society of Nuclear Medicine.  1999 Feb (revised 2004 Jun 2).  6 pages.  NGC:004260

Procedure guideline for gallium scintigraphy in inflammation.
Society of Nuclear Medicine.  1999 Feb (revised 2004 Jun 2).  5 pages.  NGC:004259

[ CLOSE WINDOW ]

Keywords

spinal infections, pyogenic vertebral osteomyelitis, vertebral infection, bacterial osteomyelitis, infectious osteomyelitis, pyogenic vertebral infections, diskitis, epidural abscess

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Federico C Vinas, MD, Consulting Neurosurgeon, Department of Neurological Surgery, Halifax Medical Center
Federico C Vinas, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, Congress of Neurological Surgeons, Florida Medical Association, and North American Spine Society
Disclosure: Nothing to disclose.

Coauthor(s)

J Richard Rhodes, MD, Orthopedic Surgeon, Atlantic Orthopaedics, PA, and Coastal Medical Research
J Richard Rhodes, MD is a member of the following medical societies: Florida Medical Association and Florida Orthopaedic Society
Disclosure: Nothing to disclose.

Amy L Stumpf, MPH, PA-C, Clinical Director, Assistant Professor, Physician Assistant Program, Nova Southeastern University
Disclosure: Nothing to disclose.

Medical Editor

James F Kellam, MD, Vice-Chair, Department of Orthopedic Surgery, Director of Orthopedic Trauma and Education, Carolinas Medical Center
James F Kellam, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

William O Shaffer, MD, Professor, Vice-Chairman and Residency Program Director, Department of Orthopedic Surgery, University of Kentucky at Lexington
William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, International Society for the Study of the Lumbar Spine, Kentucky Medical Association, Kentucky Orthopaedic Society, North American Spine Society, Southern Medical Association, and Southern Orthopaedic Association
Disclosure: DePuySpine 1997-2007 (not presently) Royalty Consulting; DePuySpine 2002-2007 (closed) Grant/research funds SacroPelvic Instrumentation Biomechanical Study; DePuyBiologics 2005-2008 (closed) Grant/research funds Healos study just closed; No present Industry grants or funds. None None

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Mary Ann E Keenan, MD, Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania
Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association
Disclosure: Nothing to disclose.

RELATED MEDSCAPE ARTICLES
Articles
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.