Risk factors and prognosis of vertebral compressive fracture in pyogenic vertebral osteomyelitis

• Published in: Infection Vol. 44; no. 1; pp. 29 - 37
• Main Authors: Ribera, Alba, Labori, Maria, Hernández, Javier, Lora-Tamayo, Jaime, González-Cañas, Lluís, Font, Federic, Nolla, Joan M., Ariza, Javier, Narváez, José A., Murillo, Oscar
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2016; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Antibiotics; Family Medicine; Female; General Practice; Humans; Infectious Diseases; Internal Medicine; Male; Medicine; Medicine & Public Health; Microbiology; Microorganisms; Middle Aged; Original Paper; Osteomyelitis - complications; Osteomyelitis - pathology; Prognosis; Retrospective Studies; Risk Factors; Spinal Fractures - epidemiology; Spinal Fractures - pathology; Vertebral compressive fracture; Pyogenic vertebral osteomyelitis; Spodylodiscitis; Vertebral collapse
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-015-0800-z

Objectives
To analyse the clinical, microbiological and radiological characteristics, and to identify risk factors of vertebral compressive fracture (VF) in spontaneous pyogenic vertebral osteomyelitis (VO).
Methods
A retrospective clinical study and blinded radiological review of adult patients with VO.
Results
Eighty-eight patients were included: 57 (65 %) had a definitive diagnosis of VO (positive microbiology), and 31 (35 %) had a probable diagnosis of VO. Of these, 27 (30.7 %) presented with VF at diagnosis of VO, and 4 afterwards (total 31, 35.2 %). Patients with VF were considered to be at higher risk of osteopenia—they were older (74 vs 66 years,
p
 = 0.013), and included high percentage of women (33 vs 41 %, NS)—; and presented more dorsal involvement (56 vs 21 %;
p
 < 0.007). Causal microorganisms were similar between groups (VF, no VF). The time to diagnosis of VO was longer in the presence of VF (65 vs 23 days,
p
 = 0.001), and also in cases with no isolated organisms. All patients received antibiotics, and just one patient required spinal stabilisation (VF). After 357 median days of follow-up, all patients were cured. Clinical improvement (residual pain, functional recovery) tended to be slower in patients with VF (log-rank 0.19 and 0.15, respectively), but clinical symptoms were similar in most patients at the last follow-up (VF, no VF).
Conclusions
VF is a common complication in pyogenic VO that causes slower clinical recovery. Risk factors of VF are: osteopenia, a delayed diagnosis and dorsal involvement. Conservative management is probably appropriate for most cases, but spinal stabilisation should be considered in some specific cases.