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Pyogenic Osteomyelitis
Kevin R. Moore, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Pyogenic spondylodiscitis, disc space infection (DSI)
            • 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. Cox M et al: Utility of sagittal MR imaging of the whole spine in cases of known or suspected single-level spinal infection: overkill or good clinical practice? Clin Imaging. 51:98-103, 2018
                                          2. Babic M et al: Infections of the spine. Infect Dis Clin North Am. 31(2):279-97, 2017
                                          3. Torres C et al: Imaging of spine infection. Semin Roentgenol. 52(1):17-26, 2017
                                          4. Berbari EF et al: 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis. 61(6):e26-46, 2015
                                          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

                                                    TERMINOLOGY

                                                    • Synonyms

                                                      • Pyogenic spondylodiscitis, disc space infection (DSI)
                                                    • 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. Cox M et al: Utility of sagittal MR imaging of the whole spine in cases of known or suspected single-level spinal infection: overkill or good clinical practice? Clin Imaging. 51:98-103, 2018
                                                                                  2. Babic M et al: Infections of the spine. Infect Dis Clin North Am. 31(2):279-97, 2017
                                                                                  3. Torres C et al: Imaging of spine infection. Semin Roentgenol. 52(1):17-26, 2017
                                                                                  4. Berbari EF et al: 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis. 61(6):e26-46, 2015
                                                                                  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