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.
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Epidemiology
Pyogenic spondylitis commonly occurs in adults in their fifth decade, and males are affected twice as often as females 1,2. The vertebral body and intervertebral disc are commonly involved.
Risk factors
sepsis
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malnourishment
malignancy
long-term steroid use
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substance use disorders
recent trauma or a spinal procedure
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 neighboring 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 the urinary system, Pseudomonas aeruginosa in intravenous drug users, and Klebsiella pneumoniae in alcohol users.
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
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tuberculous spondylitis
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