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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 unresponsive to conservative therapy
- Paravertebral or epidural abscess may develop
Differential Diagnosis
Evaluation
- 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
Management
- Antibiotics
- Usually requires IV antibiotic x6wk, then PO antibiotic x 4-8wk
- Consult with spine surgeon before starting antibiotics (may interfere with biopsy culture)
- Piperacillin-tazobactam 3.375gm IV + vancomycin 1gm IV
Disposition
- Normally, initially inpatient treatment
References
