Vertebral osteomyelitis
Revision as of 23:50, 5 June 2015 by Rossdonaldson1 (talk | contribs)
Background
Clinical Features
- Usually have had prolonged symptoms (pain >3mo)
- At risk for recent bacteremia
- Fever is a feature - however, often afebrile
- Vertebral body tenderness
- Paravertebral muscle spasm unreponsive to conservative therapy
- Paravertebral or epidural abscess may develop
Differential Diagnosis
Spinal infection
Diagnosis
- ESR (almost always elevated)
- Blood cultures
- Imaging
- May take 2-8 weeks to see changes
- Bony destruction, irregularity of vertebral end places, disk space narrowing
Treatment
- Antibiotics
- Usually requires IV abx x6wk, then PO abx x 4-8wk
- Consult with spine surgeon before starting antibiotics (may interfere with biopsy culture)
- Piperacillin-tazobactam 3.375gm IV + vanco 1gm IV