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, spondylodiskitis, and epidural abscess.
This article is a general discussion of pyogenic spondylitis. Specific radiographic features of each subtype are discussed in detail separately.
Pyogenic spondylitis commonly occurs in adults in their fifth decade, and males are affected twice as often as females 1,2. Vertebral body and intervertebral disc are commonly involved.
- diabetes mellitus
- substance abuse
- intravenous drugs
- alcohol abuse
- recent trauma or a spinal procedure
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.
Bacterial gain access via three mechanisms:
- hematogenous dissemination from a remote focal infection
- direct invasion from a neighboring infected structure: diskitis-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.
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.
- tuberculous spondylitis
- 1. Jung NY, Jee WH, Ha KY, Park CK, Byun JY. Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI. (2004) AJR. American journal of roentgenology. 182 (6): 1405-10. doi:10.2214/ajr.182.6.1821405 - Pubmed
- 2. Cheung WY, Luk KD. Pyogenic spondylitis. (2012) International orthopaedics. 36 (2): 397-404. doi:10.1007/s00264-011-1384-6 - Pubmed
- 3. Buchelt M, Lack W, Kutschera HP, Katterschafka T, Kiss H, Schneider B, Kotz R. Comparison of tuberculous and pyogenic spondylitis. An analysis of 122 cases. (1993) Clinical orthopaedics and related research. Pubmed
- 4. Lee KY. Comparison of pyogenic spondylitis and tuberculous spondylitis. (2014) Asian spine journal. 8 (2): 216-23. doi:10.4184/asj.2014.8.2.216 - Pubmed