Native Vertebral Osteomyelitis in Adults
Key Points
Key Points
NVO is commonly monomicrobial and most frequently due to Staphylococcus aureus.
The diagnosis of NVO is often delayed and often initially managed as degenerative spine disease.
NVO is typically diagnosed in the setting of recalcitrant back pain unresponsive to conservative measures and elevated systemic inflammatory markers with or without fever.
The majority of patients are cured with a 6 week course of antimicrobial therapy, but some patients may need surgical debridement and/or spinal stabilization during or after a course of antimicrobial therapy.
Diagnosis
Diagnos...
...er, (S/L)675...
...ed ESR or CRP, (S/L)675...
...oodstream infection or infective endocard...
...nd new neurologic symptoms with or w...
...ed neck or back pain, following a recent episode...
...commends performing a pertinent medic...
...obtaining bacterial (aerobic and anaerob...
...ds a spine MRI in patients with suspected NV...
...uggests a combination spine gallium/Tc99 bon...
...recommends obtaining blood cultures and serology...
...obtaining fungal blood cultures in patients with...
...performing a purified protein derivative (PPD) te...
...n patients with suspected NVO, evalua...
...s an image-guided aspiration biopsy in pa...
IDSA advises against performing an im...
IDSA advises against performing an i...
...ith neurologic compromise with or without...
...suggests the addition of fungal, mycobac...
...A suggests the addition of fungal and mycobacte...
...ssue can be safely obtained, pathol...
...ence of concomitant bloodstream in...
...s with a non-diagnostic first image-g...
...patients with suspected NVO and a non-diagnostic...
Treatment
...atment...
...tibiotics...
...th normal and stable neurologic exam and...
...patients with hemodynamic instability, seps...
...ecommends a total duration of 6 weeks of parente...
IDSA recommends a total duration of 3 mont...
Surgery
...mmends surgical intervention in patients wit...
...SA suggests surgical debridement wit...
...es against surgical debridement and/or stabiliza...
Follow-Up
...low-Up
...temic Inflammatory Markers...
IDSA suggests monitoring systemic inflammat...
...mends against routinely ordering foll...
...s performing a follow-up MRI to asses...
...re of Therap...
...uggests that persistent pain, residual neurolo...
...ents with NVO and suspected treatment failure, IDS...
...s obtaining a follow-up MRI with emphasis...
...s with NVO and clinical and radiographic...
...h NVO and clinical and radiographic evidence of t...
...ure 1. Evaluation
...ure 2. Management...
...Parenteral Antimicrobial Treatment of Commo...
...elected Oral Antibacterial Agents wit...