Management of vertebral diskitis and osteomyelitis

• Published in: Orthopedics (Thorofare, N.J.) Vol. 22; no. 8; pp. 758 - 765
• Main Authors: KHAN, I. A, VACCARO, A. R, ZLOTOLOW, D. A
• Format: Journal Article
• Language: English
• Published: Thorofare, NJ Slack 01.08.1999; SLACK INCORPORATED
• Subjects: Anti-Bacterial Agents - therapeutic use; Bacterial arthritis and osteitis; Bacterial diseases; Biological and medical sciences; Bone Transplantation; Combined Modality Therapy; Debridement; Diagnosis, Differential; Discitis - diagnosis; Discitis - epidemiology; Discitis - etiology; Discitis - therapy; Human bacterial diseases; Humans; Infectious diseases; Medical sciences; Osteomyelitis - diagnosis; Osteomyelitis - epidemiology; Osteomyelitis - etiology; Osteomyelitis - therapy; Risk Factors; Spinal Diseases - diagnosis; Spinal Diseases - epidemiology; Spinal Diseases - etiology; Spinal Diseases - therapy; Spinal Fusion; Treatment Outcome; Human; Diseases of the osteoarticular system; Vertebra; Bone disease; Spine disease; Review; Epidemiology; Infection; Spondylitis; Treatment; Etiology; Osteitis; Medical imagery; Diagnosis; Public health
• DOI: 10.3928/0147-7447-19990801-07
• ISSN: 0147-7447

The clinical presentation and demographic features of patients with vertebral diskitis and osteomyelitis have gradually changed over the past several decades with advances in medical care and the aging of the population. In North America, clinically challenging spinal infections often are encountered in the elderly immunocompromised patient or in patients with long-term illicit intravenous drug abuse. Often, the management of vertebral osteomyelitis and diskitis is addressed in general terms without regard to patient age. However, due to differences in the vascular anatomy of the intervertebral disks at different ages, the management of a child with a spinal infection is more predictable and often associated with less morbidity than in the adult patient. In the child, vessels penetrate into the nucleus pulposus, while in adulthood, the vessels enter only into the annulus fibrosus. It is hypothesized that the etiology of adult vertebral osteomyelitis is the deposition of infected emboli within the vertebral body metaphysis resulting in bony ischemia and infarct. Following this, bony destruction ensues with eventual spread of the invading bacterium into the contiguous disk space. In the child, bacterial emboli may be deposited within the disk itself.