Infection
Pyogenic Vertebral Osteomyelitis: A Systematic Review of Clinical Characteristics

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Objectives

Vertebral osteomyelitis is a cause of back pain that can lead to neurologic deficits if not diagnosed in time and effectively treated. The objective of this study was to systematically review the clinical characteristics of pyogenic vertebral osteomyelitis (PVO).

Methods

The authors conducted a systematic review of the English literature. The inclusion criteria included studies with 10 or more subjects diagnosed with PVO based on the combination of clinical presentation with either a definitive bacteriologic diagnosis or pathological and/or imaging studies.

Results

The 14 studies that met selection criteria included 1008 patients with PVO. Of them, the majority (62%) were men, with back pain and fever as the most common presenting symptoms. Diabetes mellitus was the most common underlying medical illness, while the urinary tract was the commonest source of infection. Staphylococcus aureus was the most commonly isolated organism. Computed tomographic guided or open biopsy yielded the causative organism more often than blood cultures (77% versus 58%). Plain radiography showed abnormalities in 89% of the cases, while bone scanning and computed tomography or magnetic resonance imaging were positive in 94% of the cases, revealing lumbar as the most commonly affected area. The attributable mortality was 6%, while relapses and neurological deficits were described in the 32% and 32% of the cases, respectively.

Conclusion

PVO is an illness of middle-aged individuals with underlying medical illnesses. Although the mortality rate is low, relapses and neurological deficits are common, making early diagnosis a major challenge for the physician.

Section snippets

Literature Search

We collected the literature by searching the MEDLINE database starting with 1966. We also used textbooks of infectious diseases and orthopedics. The MEDLINE search string was “Discitis”[Mesh] OR “vertebral osteomyelitis” OR “spinal osteomyelitis” OR spondylodiscitis OR spondylitis NOT ankylosing NOT “case reports” [pt]. The results were limited to human studies published in the English language. Manual searches of reference lists from potentially relevant papers and book chapters were also

Study Characteristics and Limitations

Epidemiological, clinical, and microbiological aspects of PVO require careful interpretation for 2 reasons: (a) there is heterogeneity of the inclusion criteria among studies. Thus, 2 reports (10, 19) excluded drug abusers and 5 (10, 12, 16, 21, 23) excluded postoperative infections. On the contrary, in 1 report (14) intravenous drug abusers constituted the majority of the included patients. (b) Almost all the studies (93%) are retrospective, in which there is a potential for error because of

Discussion

We performed a systematic review of all PVO studies and identified 14 retrospective studies, including 1008 patients with PVO and excluding patients with tuberculosis and brucellosis. Based on these studies, we tried to clarify demographic, clinical, and microbiological characteristics of the disease, the contribution of various diagnostic procedures, and imaging studies to the etiological diagnosis of the disease, with particular attention to patient outcome.

PVO was found to affect mainly men

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