Pyogenic spondylitis

Changed by Andrew Murphy, 25 Feb 2019
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Pyogenic spondylitis refers to infections of the spine which involve the vertebrae, intervertebral disc, paraspinal soft tissue, or epidural space 1,2. It is a broad term that includes vertebral osteomyelitis, spondylodiscitis, and epidural abscess.

This article is a general discussion of pyogenic spondylitis. Specific radiographic features of each subtype are discussed in detail separately.

Epidemiology

Pyogenic spondylitis commonly occurs in adults atin their fifth decade, and males are affected twice as often as females 1,2.  VertebralVertebral body and intervertebral disc are commonly involved.

Risk factors

Clinical presentation

The disease typically presents with back pain and fever. There may be neurological involvement, such as from nerve root or cord compression.

In pyogenic spondylitis, symptoms tend to present earlier compared with tuberculous spondylitis 3.

Pathology

Bacterial gain access via three mechanisms:

  • hematogenous dissemination from a remote focal infection
  • direct invasion from a neighbouring infected structure: discitis-osteomyelitis, septic arthritis
  • iatrogenic inoculation: epidural/spinal anesthetics, steroid injections, surgery iatrogenic

The most common causative organism is Staphylococcus aureus and Streptococcus spp. Other potential organisms include E.coli and Proteus spp. from urinary system, Pseudomonas aeruginosa in intravenous drug users, and Klebsiella pneumoniae in alcohol abusers.

Radiographic features

Specific radiographic features of each subtype are discussed separately. Please refer to the respective articles:

Treatment and prognosis

Although the majority of patients responds to antibiotic treatment, some may require surgical intervention, particularly in patients complicated with spinal cord or cauda equina compression.

Differential diagnosis

  • -<p><strong>Pyogenic spondylitis</strong> refers to infections of the spine which involve the vertebrae, intervertebral disc, paraspinal soft tissue, or epidural space <sup>1,2</sup>. It is a broad term that includes vertebral <a href="/articles/osteomyelitis">osteomyelitis</a>, <a href="/articles/spondylodiscitis">spondylodiscitis</a>, and <a href="/articles/spinal-epidural-abscess">epidural abscess</a>.</p><p>This article is a general discussion of pyogenic spondylitis. Specific radiographic features of each subtype are discussed in detail separately.</p><h4>Epidemiology</h4><p>Pyogenic spondylitis commonly occurs in adults at their fifth decade, and males are affected twice as often as females <sup>1,2</sup>.  Vertebral body and intervertebral disc are commonly involved.</p><h5>Risk factors</h5><ul>
  • -<li><a title="Diabetes mellitus" href="/articles/diabetes-mellitus">diabetes mellitus</a></li>
  • +<p><strong>Pyogenic spondylitis</strong> refers to infections of the spine which involve the vertebrae, intervertebral disc, paraspinal soft tissue, or epidural space <sup>1,2</sup>. It is a broad term that includes vertebral <a href="/articles/osteomyelitis">osteomyelitis</a>, <a href="/articles/spondylodiscitis">spondylodiscitis</a>, and <a href="/articles/spinal-epidural-abscess">epidural abscess</a>.</p><p>This article is a general discussion of pyogenic spondylitis. Specific radiographic features of each subtype are discussed in detail separately.</p><h4>Epidemiology</h4><p>Pyogenic spondylitis commonly occurs in adults in their fifth decade, and males are affected twice as often as females <sup>1,2</sup>. Vertebral body and intervertebral disc are commonly involved.</p><h5>Risk factors</h5><ul>
  • +<li><a href="/articles/diabetes-mellitus">diabetes mellitus</a></li>
  • -<li><a title="HIV" href="/articles/hivaids">HIV infection</a></li>
  • +<li><a href="/articles/hivaids">HIV infection</a></li>
  • -<li><a title="Chronic renal failure" href="/articles/chronic-kidney-disease">chronic renal failure</a></li>
  • -<li><a title="Cirrhosis" href="/articles/cirrhosis">cirrhosis</a></li>
  • +<li><a href="/articles/chronic-kidney-disease">chronic renal failure</a></li>
  • +<li><a href="/articles/cirrhosis">cirrhosis</a></li>

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