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Treatment. Vertebral osteomyelitis

By Editorial Team (A)
November 29, 2021
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Generally, vertebral osteomyelitis is a secondary complication following infection with bacterial blood seeding. As a result, infection signs may initially overshadow those of vertebral osteomyelitis. Moreover, this condition shares many symptoms with a lot of other diseases. The time difference between the onset of symptoms and diagnosis is often significant due to these complications (five studies showed that it might range from 42 to 59 days). Nevertheless, proper diagnosis is essential to manage vertebral osteomyelitis.

Vertebral osteomyelitis diagnostics

To diagnose vertebral osteomyelitis, the doctor usually recommends performing various tests that help identify the condition. They may include:

  • blood tests (including blood cultures)
  • biopsy
  • imaging tests such as:
    • plain radiography
    • magnetic resonance imaging (MRI)
    • computerized tomography (CT) scan

Vertebral osteomyelitis treatment

The doctor creates a treatment plan for a person with vertebral osteomyelitis individually for every patient. The healthcare provider considers the general health condition, neurologic status, biomechanical factors of the affected individual, and whether the person has associated abscesses. Treatment options include medications and surgery.

Vertebral osteomyelitis medications

It is essential to treat any underlying infection to cure the vertebral infection. Antibiotic treatment must target the specific organism. However, the doctor may prescribe broad-spectrum antibiotics initially until the pathogen is identified. In most cases, an infectious organism that results in vertebral osteomyelitis is sensitive to antibiotics. However, on rare occasions, the pathogen may lack response to these medications.

Antibiotic treatment can last for variable periods. Usually, 6-8 weeks of parenteral antibiotic therapy helps manage vertebral osteomyelitis. Nevertheless, before the patient stops taking these medications, the doctor must ensure that:

  • erythrocyte sedimentation rate (ESR) dropped at least two-thirds compared to before treatment
  • the patient doesn’t have a fever
  • the patient doesn’t experience pain when moving
  • the patient doesn’t exhibit any complications related to vertebral osteomyelitis

Notably, in cases when infection continues despite taking antibiotics, the doctor can suggest an additional biopsy of the affected vertebra. This procedure helps determine if the pathogen doesn’t respond to the selected antibiotic.

Antibiotic options to treat vertebral osteomyelitis may include:

  • Vancomycin
  • Nafcillin
  • Gentamicin
  • Ceftazidime

The medication chosen depends on the type of bacteria affecting the patient and the overall health condition of this person.

Unfortunately, even after successful treatment of some forms of vertebral osteomyelitis, some degree of vertebral body collapse may still occur. The greater the amount of bone destruction present before treatment, the greater the likelihood of eventual kyphosis. Therefore, after antibiotic treatment, the patient must monitor the spine using sequential radiographs. Kyphosis formation may lead to eventual neural impingement, and the kyphosis itself may require late surgical correction. In addition, conditions like significant kyphosis, infection behind the vertebral body under the posterior longitudinal ligament, or infection in the epidural space can cause neurologic deterioration.

Vertebral osteomyelitis surgery

Although most patients with vertebral osteomyelitis respond to medical management, certain cases may require surgery. Indications for surgery include:

  • significant osseous involvement
  • neurologic deficits
  • septic course with clinical toxicity from an abscess not responding to antibiotics
  • failure of needle biopsy to obtain necessary cultures
  • failure of intravenous antibiotics alone to eradicate the infection

Goals of surgery include preservation of neural function and achievement of stable bony fusion without severe kyphosis, which can lead to neural compromise or disabling radicular pain.

Prevention of vertebral osteomyelitis

It’s not always possible to prevent vertebral osteomyelitis development. However, you can take some measures to reduce the chances of getting it. They include:

  • take proper care of wounds
  • improve general health

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