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Pyogenic Osteomyelitis
Kevin R. Moore, MD
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25
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Pyogenic spondylodiscitis, disc space infection
              • Definitions

                • Bacterial suppurative infection of vertebrae and intervertebral disc

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Nuclear Medicine Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Kim UJ et al: Comparison of pyogenic postoperative and native vertebral osteomyelitis. Spine J. 19(5):880-7, 2019
                                            2. Boody BS et al: Evaluation and management of pyogenic and tubercular spine infections. Curr Rev Musculoskelet Med. 11(4):643-52, 2018
                                            3. Dayer R et al: Spinal infections in children: a multicentre retrospective study. Bone Joint J. 100-B(4):542-8, 2018
                                            4. Lemaignen A et al: Characteristics of and risk factors for severe neurological deficit in patients with pyogenic vertebral osteomyelitis: a case-control study. Medicine (Baltimore). 96(21):e6387, 2017
                                            5. Falip C et al: Chronic recurrent multifocal osteomyelitis (CRMO): a longitudinal case series review. Pediatr Radiol. 43(3):355-75, 2013
                                            6. Shimizu H et al: Vertebral osteomyelitis caused by non-tuberculous mycobacteria: case reports and review. J Infect Chemother. 19(5):972-7, 2013
                                            7. Fantoni M et al: Epidemiological and clinical features of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci. 16 Suppl 2:2-7, 2012
                                            8. Luzzati R et al: The empirical antibiotic therapy of pyogenic vertebral osteomyelitis. Semin Arthritis Rheum. 41(4):e9, 2012
                                            9. Metz LN et al: Infectious, inflammatory, and metabolic diseases affecting the athlete's spine. Clin Sports Med. 31(3):535-67, 2012
                                            10. Pola E et al: Medical and surgical treatment of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci. 16 Suppl 2:35-49, 2012
                                            11. Sehn JK et al: Percutaneous needle biopsy in diagnosis and identification of causative organisms in cases of suspected vertebral osteomyelitis. Eur J Radiol. 81(5):940-6, 2012
                                            12. Oztekin O et al: Brucellar spondylodiscitis: magnetic resonance imaging features with conventional sequences and diffusion-weighted imaging. Radiol Med. 115(5):794-803, 2010
                                            13. de Lucas EM et al: CT-guided fine-needle aspiration in vertebral osteomyelitis: true usefulness of a common practice. Clin Rheumatol. 28(3):315-20, 2009
                                            14. Mylona E et al: Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum. 39(1):10-7, 2009
                                            15. Toussirot E et al: Spinal cord compression complicating aseptic spondylodiscitis in ankylosing spondylitis. Clin Exp Rheumatol. 27(4):654-7, 2009
                                            16. Dai LY et al: Anterior instrumentation for the treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine. Eur Spine J. 17(8):1027-34, 2008
                                            17. O'Daly BJ et al: Long-term functional outcome in pyogenic spinal infection. Spine (Phila Pa 1976). 33(8):E246-53, 2008
                                            18. Kowalski TJ et al: Follow-up MR imaging in patients with pyogenic spine infections: lack of correlation with clinical features. AJNR Am J Neuroradiol. 28(4):693-9, 2007
                                            19. Solis Garcia del Pozo J et al: Vertebral osteomyelitis: long-term disability assessment and prognostic factors. J Infect. 54(2):129-34, 2007
                                            20. Ledermann HP et al: MR imaging findings in spinal infections: rules or myths? Radiology. 228(2):506-14, 2003
                                            21. Love C et al: Diagnosing spinal osteomyelitis: a comparison of bone and Ga-67 scintigraphy and magnetic resonance imaging. Clin Nucl Med. 25(12):963-77, 2000
                                            22. Wagner SC et al: Can imaging findings help differentiate spinal neuropathic arthropathy from disk space infection? Initial experience. Radiology. 214(3):693-9, 2000
                                            23. Carragee EJ: The clinical use of magnetic resonance imaging in pyogenic vertebral osteomyelitis. Spine. 22(7):780-5, 1997
                                            24. Dagirmanjian A et al: MR imaging of vertebral osteomyelitis revisited. AJR Am J Roentgenol. 167(6):1539-43, 1996
                                            25. Thrush A et al: MR imaging of infectious spondylitis. AJNR Am J Neuroradiol. 11(6):1171-80, 1990
                                            26. Modic MT et al: Vertebral osteomyelitis: assessment using MR. Radiology. 157(1):157-66, 1985
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Synonyms

                                                          • Pyogenic spondylodiscitis, disc space infection
                                                        • Definitions

                                                          • Bacterial suppurative infection of vertebrae and intervertebral disc

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Nuclear Medicine Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Gross Pathologic & Surgical Features

                                                                          • Microscopic Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Kim UJ et al: Comparison of pyogenic postoperative and native vertebral osteomyelitis. Spine J. 19(5):880-7, 2019
                                                                                      2. Boody BS et al: Evaluation and management of pyogenic and tubercular spine infections. Curr Rev Musculoskelet Med. 11(4):643-52, 2018
                                                                                      3. Dayer R et al: Spinal infections in children: a multicentre retrospective study. Bone Joint J. 100-B(4):542-8, 2018
                                                                                      4. Lemaignen A et al: Characteristics of and risk factors for severe neurological deficit in patients with pyogenic vertebral osteomyelitis: a case-control study. Medicine (Baltimore). 96(21):e6387, 2017
                                                                                      5. Falip C et al: Chronic recurrent multifocal osteomyelitis (CRMO): a longitudinal case series review. Pediatr Radiol. 43(3):355-75, 2013
                                                                                      6. Shimizu H et al: Vertebral osteomyelitis caused by non-tuberculous mycobacteria: case reports and review. J Infect Chemother. 19(5):972-7, 2013
                                                                                      7. Fantoni M et al: Epidemiological and clinical features of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci. 16 Suppl 2:2-7, 2012
                                                                                      8. Luzzati R et al: The empirical antibiotic therapy of pyogenic vertebral osteomyelitis. Semin Arthritis Rheum. 41(4):e9, 2012
                                                                                      9. Metz LN et al: Infectious, inflammatory, and metabolic diseases affecting the athlete's spine. Clin Sports Med. 31(3):535-67, 2012
                                                                                      10. Pola E et al: Medical and surgical treatment of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci. 16 Suppl 2:35-49, 2012
                                                                                      11. Sehn JK et al: Percutaneous needle biopsy in diagnosis and identification of causative organisms in cases of suspected vertebral osteomyelitis. Eur J Radiol. 81(5):940-6, 2012
                                                                                      12. Oztekin O et al: Brucellar spondylodiscitis: magnetic resonance imaging features with conventional sequences and diffusion-weighted imaging. Radiol Med. 115(5):794-803, 2010
                                                                                      13. de Lucas EM et al: CT-guided fine-needle aspiration in vertebral osteomyelitis: true usefulness of a common practice. Clin Rheumatol. 28(3):315-20, 2009
                                                                                      14. Mylona E et al: Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum. 39(1):10-7, 2009
                                                                                      15. Toussirot E et al: Spinal cord compression complicating aseptic spondylodiscitis in ankylosing spondylitis. Clin Exp Rheumatol. 27(4):654-7, 2009
                                                                                      16. Dai LY et al: Anterior instrumentation for the treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine. Eur Spine J. 17(8):1027-34, 2008
                                                                                      17. O'Daly BJ et al: Long-term functional outcome in pyogenic spinal infection. Spine (Phila Pa 1976). 33(8):E246-53, 2008
                                                                                      18. Kowalski TJ et al: Follow-up MR imaging in patients with pyogenic spine infections: lack of correlation with clinical features. AJNR Am J Neuroradiol. 28(4):693-9, 2007
                                                                                      19. Solis Garcia del Pozo J et al: Vertebral osteomyelitis: long-term disability assessment and prognostic factors. J Infect. 54(2):129-34, 2007
                                                                                      20. Ledermann HP et al: MR imaging findings in spinal infections: rules or myths? Radiology. 228(2):506-14, 2003
                                                                                      21. Love C et al: Diagnosing spinal osteomyelitis: a comparison of bone and Ga-67 scintigraphy and magnetic resonance imaging. Clin Nucl Med. 25(12):963-77, 2000
                                                                                      22. Wagner SC et al: Can imaging findings help differentiate spinal neuropathic arthropathy from disk space infection? Initial experience. Radiology. 214(3):693-9, 2000
                                                                                      23. Carragee EJ: The clinical use of magnetic resonance imaging in pyogenic vertebral osteomyelitis. Spine. 22(7):780-5, 1997
                                                                                      24. Dagirmanjian A et al: MR imaging of vertebral osteomyelitis revisited. AJR Am J Roentgenol. 167(6):1539-43, 1996
                                                                                      25. Thrush A et al: MR imaging of infectious spondylitis. AJNR Am J Neuroradiol. 11(6):1171-80, 1990
                                                                                      26. Modic MT et al: Vertebral osteomyelitis: assessment using MR. Radiology. 157(1):157-66, 1985