Vertebral Osteomyelitis - A Rare Spinal Bone Infection

Introduction

Vertebral osteomyelitis accounts for about four to five percent of all cases in a year. Vertebral osteomyelitis has a nonspecific clinical presentation along with a delayed diagnosis of up to several months. Vertebral osteomyelitis develops after a trauma to the spine, hematogenous spread, or post-surgery from an adjacent site. This infection has high morbidity and can lead to paraplegia, spinal deformity, and death if left untreated.

What Is Vertebral Osteomyelitis?

Osteomyelitis is a painful bone infection that develops from fungi or bacteria. Vertebral osteomyelitis is a rare infection that occurs after spine injury or surgery. Hematogenous spread is the primary route of the spread of vertebral osteomyelitis. It spreads from the body to the spine into the bloodstream. Besides the arterial spread, retrograde seeding of the venous blood through the Batson plexus. It can spread the infection to the spinal cord. Vertebral osteomyelitis is also called spinal osteomyelitis or spondylodiskitis. Vertebral osteomyelitis affects men more than women and increases with age. People at risk of developing vertebral osteomyelitis are people in a nursing home, people on dialysis, sickle cell disease, and infection through needles.

What Are the Signs and Symptoms of Vertebral Osteomyelitis?

Vertebral osteomyelitis symptoms include persistent, severe back pain aggravated at night or by sudden movements. It affects the region of the spinal column, including (cervical) neck, lower back (lumbar), mid back (thoracic), and sacrum (sacral). In addition, the pain may radiate into other body parts depending upon the parts affected. The signs and symptoms of vertebral osteomyelitis may include the following:

• Weight loss.

• Numbness.

• Swelling.

• Fever.

• Sweating.

• Weakness.

• Malaise.

• Burning sensation.

• Weakness.

• Tingling.

• Back pain worsens when one moves and does not get better with home remedies, heat application, or rest.

Bone infections like vertebral osteomyelitis are not contagious. But the germs that cause vertebral osteomyelitis are infectious. In addition, one can pass actual germs to one another.

What Causes Vertebral Osteomyelitis?

Vertebral osteomyelitis is an infection of a single pathogen. The bacterium Staphylococcus aureus causes vertebral osteomyelitis. Staphylococcus infection is a very common and serious infection. Vertebral osteomyelitis can also be caused by Mycobacterium tuberculosis or any fungi. The bone infection can spread from soft tissue if they are infected. Bedsores and urinary tract infections can infect the body as well as bones.

How Is Vertebral Osteomyelitis Diagnosed?

The signs and symptoms of vertebral osteomyelitis resemble other diseases. Therefore, the healthcare provider will examine, take the complete medical history, and order diagnostic tests. The following tests will be recommended.

• Blood Tests - Blood tests help diagnose inflammation, erythrocyte sedimentation rate, or the protein white blood cells in the blood. Along with the blood, the pus, tissue, and fluid from the bone and the joint can be examined to find the cause of the infection.

• Imaging Tests - Imaging tests such as computed tomography (CT) scans, magnetic resonance imaging (MRI), and X-rays help diagnose problems.

• Biopsy - During a biopsy, the surgeon removes pieces or parts of the tissue for diagnosis.

What Is the Differential Diagnosis of Vertebral Osteomyelitis?

The differential diagnosis includes:

• Gout.

• Gaucher disease.

• Septic arthritis.

• Spondylosis.

• Sickle cell anemia.

• Vertebral compression fracture.

• Ewing sarcoma.

• Malignancy.

• Vitamin C deficiency.

• Vaso-occlusive episode.

• Pseudogout.

How Is Vertebral Osteomyelitis Treated?

To treat vertebral osteomyelitis, the healthcare provider will prescribe antibiotics or antimicrobials in non-oral and oral forms. The duration of the treatment will be around six weeks. Along with the antibiotic course, the healthcare provider will also suggest a back brace to help stabilize the spine and improve muscle strength. In addition, surgery will help to drain the pus from the infected area and stabilize the vertebrae.

How to Prevent Vertebral Osteomyelitis?

Usually, men are at higher risk of developing vertebral osteomyelitis than women. But there are a few risk factors that will aggravate vertebral osteomyelitis. The preventive measures that must be followed to reduce the risk of vertebral osteomyelitis are:

• Avoid skin infections or skin injuries.

• Follow a healthy lifestyle by exercising well, eating well, and getting an adequate amount of sleep.

• Manage and control diabetes by following the proper lifestyle.

• Avoid sharing needles.

• Avoid using infected needles and injecting a drug that has not been prescribed by the doctor.

What Are the Risk Factors for Vertebral Osteomyelitis?

The risk factors for vertebral osteomyelitis include

• IV drug use.

• Malignancy.

• Malnutrition.

• Long-term corticosteroid use.

• Diabetes.

• Older age.

• Immunosuppression.

How Is the Prognosis of Vertebral Osteomyelitis?

Even if the patient gets treated for vertebral osteomyelitis, the recovery of the patient gets prolonged. Some cases of vertebral osteomyelitis require multiple procedures. In addition, the surgery has serious complications, such as paralysis and permanent neurological deficits. As a result, many patients remain disabled, and their quality of life is hampered.

What Are the Complications of Vertebral Osteomyelitis?

The complications of vertebral osteomyelitis include

• Disability.

• Chronic pain.

• Paralysis.

• Fracture.

• Recurrence of infection.

• Permanent neurological deficits.

When Should One Visit Their Healthcare Provider?

One should consult their healthcare provider when

• A person has a recurrent fever that is not controlled by medications.

• A person has undergone a dental procedure where an injected drug is causing back or neck pain.

• A person is recovering from vertebral osteomyelitis, and the symptoms worsen, or there are new symptoms.

• A person has a recent history of surgery or a urinary tract infection.

Conclusion

Vertebral osteomyelitis is a rare condition, but it can occur. Vertebral osteomyelitis is difficult to diagnose in the early stages, but it can lead to morbidity in the later stages. Therefore, people suffering from vertebral osteomyelitis must be educated regarding the prognosis, and the treatment should be discussed in detail.