• See Also
  1. Spinal Infection
  2. Osteomyelitis
  3. Osteomyelitis Causes
  4. Acute Hematogenous Osteomyelitis
  • Epidemiology
  1. Vertebral Osteomyelitis most common type of hematogenous Osteomyelitis
  • Risk Factors
  1. Extraspinal infection site
  2. Urinary tract instrumentation
  3. Indwelling vascular catheter
  4. Hemodialysis
  5. Intravenous Drug Abuse
  6. Cancer
  7. Diabetes Mellitus
  • Causes
  1. Common causes
    1. Hematogenous spread of recent infections with bacteremia
    2. Surgery (esp. recent Spine Surgery)
  2. Other causes
    1. Trauma or Animal Bites
    2. Adjacent infection spread
    3. Spine Surgery complication
  • Symptoms
  1. Severe pain in back or neck
  2. Overlying Muscle tenderness
  3. Limited spine range of motion
  4. Fever may be present
  5. Neurologic deficit may be present
  • Labs
  1. Complete Blood Count
  2. Procalcitonin
  3. C-Reactive Protein
  4. Blood Cultures before Antibiotics
  • Imaging
  1. Precautions
    1. Image the entire spine (cervical, thoracic and lumbar)
      1. Skip lesions are common in Spinal Infections (up to 15% of cases)
    2. Vertebral Osteomyelitis typically occurs below the cervical region
      1. Thoracolumbar (29%)
      2. Lumbosacral (64%)
  2. Gadolinium-enhanced Spine MRI (preferred)
    1. Test Sensitivity 96% and Test Specificity 94% for Vertebral Osteomyelitis
    2. Decreased accuracy of MRI in first 2 weeks of symptom onset
    3. Vertebral edema (T1 hypointense and T2 hyperintense signal within Vertebrae)
  3. CT with Myelography
    1. Indicated when MRI is contraindicated or unavailable
    2. Underestimates Spinal Epidural Abscess size
  • Management
  1. See Spinal Infection
  2. See Acute Osteomyelitis Management
  3. Antibiotic course for 6 weeks
    1. Start with broader Antibiotic coverages (polymicrobial in 5-10% of patients)
    2. Cover Staphylococcus Aureus including MRSA initially (most common cause of Vertebral Osteomyelitis)
    3. IV Antibiotics for at least the first 2 weeks (and then transitioned to oral Antibiotics in immunocompetent patients)
  4. Surgical intervention indications (uncommon)
    1. Neurologic deficit
    2. Spinal instability
    3. Large fluid collection
    4. Failed medical conservative therapy
  • References
  1. Hastings (2025) Crit Dec Emerg Med 39(3): 15-6
  2. Bury (2021) Am Fam Physician 104(4): 395-402 [PubMed]