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Lumbar Vertebral Osteomyelitis

What is Vertebral Osteomyelitis?

The term “vertebral osteomyelitis” describes an inflammation and infection of the bone and bone marrow of the spine. This condition is overall rare, accounting for only 2-4% of all infections in bone in the human body.

Vertebral osteomyelitis can be acute or chronic, and can affect people of all ages. Typically children and the elderly are affected the most.

Unfortunately this disease can be slow in its development which can mask its presence. Patients may have few if any symptoms until a significant infection is present often resulting in the destruction of part of the vertebrae. This infection can also easily spread to other structures such as the epidural space (spinal epidural abscess) or the disc (discitis).

How do patients get Vertebral Osteomyelitis?

The most common ways to contract vertebral osteomylelitis are:

  1. Trauma which penetrates the spine
  2. After spine surgery
  3. Spread from another infected area of the body.
  4. Intravenous drug abuse
  5. Diabetes Mellitus with poor control
  6. Patients with poor immune systems

What is the most common bacteria causing Vertebral Osteomyelitis?

The most common bacteria is Staphylococcus Aureus.

What are the symptoms of a Vertebral Osteomyelitis?

The most common symptom is ongoing spine pain for longer periods of time (often 3 months or more) which appears worse at night. The pain does not seem to change much with activity.

Patients may also experience fevers, chills, and night sweats.

How do Spine Specialists diagnose a Vertebral Osteomyelitis?

Spine specialists often use information gathered from the patient history, physical examination and special tests to make the diagnosis of a Vertebral Osteomyelitis?

  1. History

A patient history of worsening back pain, poor energy, and occasional fevers and chills may point toward a vertebral osteomyelitis.

      2. Physical Examination

The physical examination in patients with Vertebral Osteomyelitis may be essentially normal. However, here are some tests which are often done to make sure than another spine infection such as an epidural abscess is not present as well:

  1. Palpation (touch and pressure) of the spine
  2. Range of motion  of the low-back (mobility)
  3. Sensation testing of the legs
  4. Strength testing of the leg muscles (motor)
  5. Reflex testing of the legs
  6. Gait testing
  7. Kernig’s test
  8. Valsalva test
  9. Babinski sign

      3. Imaging

A. X-Rays

Plain X-Rays can show bone destruction (osteolysis) from advanced vertebral osteomyelitis. It may not show earlier stages of the disease.

B. MRI

MRI scans can show the bone destruction and the reaction of the bone marrow as well as any potential spread of the infection. A potential disc infection can also be seen. When combined with intravenous contrast this is the study of choice to make the diagnosis.

C. CT Scans

CT scans can show the bone anatomy of the vertebrae. The destruction of a vertebra can be seen with more clarity than an MRI. However, the softer spine structures such as the spinal cord, spinal nerves, and epidural space are difficult to see.

D. Nuclear Bone Scans

Nuclear bone scans are excellent tools to show an infection in a vertebra. They can sometimes show the presence of vertebral osteomyelitis before other imaging studies. However outside of the anatomy of the vertebrae, not much else can be seen on a nuclear bone scan.

E. Laboratory Studies

The following laboratory studies can assist in the diagnosis of a vertebral osteomyelitis:

  1. Complete Blood Count (CBC) with differential

A Complete Blood Count (CBC) counts the cells in the blood stream. When an infection is present, the number of White Blood Cells (WBC) will increase as they try to fight the infection. Some specific types of WBC’s can also be specifically elevated (Neutrophils) making an infection even more likely.

      2. C-Reactive Protein Count

The CRP count is a measure of an inflammatory protein which increases when a severe inflammation or infection is present.

      3. Sedimentation Rate

The ESR is another measure which increases with a severe inflammation or infection.

      4. Biopsy

Sometimes a bone biopsy must be performed to make the diagnosis and to confirm which bacteria are present.

How is a Vertebral Osteomyelitis treated?

The following are common treatments for vertebral osteomyelitis

  1. Antibiotic Therapy

Intravenous antibiotics are commonly given for longer periods of time (6 weeks or more) to treat the infection. Laboratory studies are often repeated at certain times to see how the infection is responding to the antibiotics. Sometimes spine images are also repeated for the same reason.

      2. Spinal Brace

A spinal brace may give support and limit the spine’s painful motion.

      2. Surgical Care

Spine surgery is recommended if the spine is showing signs of instability and the collapse of a vertebra is imminent or has occurred. Another scenario is the presence of compression of the spinal cord, cauda equina or spinal nerves from the collapsing vertebrae or the presence of an epidural abscess. This can be an emergent situation.

Here is a surgery which is sometimes performed for a Vertebral Osteomyelitis:

1. Lumbar Vertebrectomy/Corpectomy

2. Lumbar Laminectomy