Long-Term Clinical and Radiological Magnetic Resonance Imaging Outcome of Abscess-Associated Spontaneous Pyogenic Vertebral Osteomyelitis Under Conservative Management

• Published in: Seminars in arthritis and rheumatism Vol. 38; no. 1; pp. 28 - 40
• Main Authors: Euba, Gorane, MD, Narváez, José A., MD, Nolla, Joan M., MD, PhD, Murillo, Oscar, MD, Narváez, Javier, MD, PhD, Gómez-Vaquero, Carmen, MD, PhD, Ariza, Javier, MD, PhD
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01-08-2008; Elsevier
• Subjects: abscess; Abscess - diagnosis; Abscess - drug therapy; Adult; Aged; Aged, 80 and over; Bacterial arthritis and osteitis; Bacterial diseases; Biological and medical sciences; Diseases of the osteoarticular system; Diseases of the spine; Epidural Abscess - diagnosis; Epidural Abscess - drug therapy; Female; Human bacterial diseases; Humans; Infectious diseases; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; MRI; Osteomyelitis - diagnosis; Osteomyelitis - diet therapy; Rheumatology; Spine; spondylitis; vertebral osteomyelitis; CLI; VAN; PACS; STE; CLO; neurological symptoms; PVO; NRL; STI; paravertebral; end-state renal failure-hemodialysis; late response; soft tissue edema; ESRF-HD; ABS Red; PREV; LNZ; vancomycin; C reactive protein; PO ATB; no extra-vertebral extension; IS; metronidazol; AP; SUR; human immunodeficiency virus; piperacillin-tazobactam; gadolinium; penicillin; MRI; CNS; anterior-posterior length in mm; abscess; paraspinal abscess; ABS; soft tissue involvement; CC; spinal canal compromise; intravenous antibiotics; ESR; ACL; STIR; picture archiving and communication system; CT; HIV; spontaneous bacterial peritonitis; TR; bronchiolitis obliterans organizing pneumonia; COPD; surgery; amoxicillin; rifampicin; LR; millimeters; DM; UTI; F-U; amoxicillin-clavulanate; short tau inversion recovery; CaCo; cloxacillin; oral antibiotics; MRSA; EA; mm; IV ATB; MDZ; erytrocyte sedimentation rate; CIP; EP; AMX; ER; prevertebral; epidural abscess; immunosuppressive therapy; ceftriaxone; NE; CRP; CRO; magnetic resonance imaging; NR; spondylitis; diabetes mellitus; pyogenic vertebral osteomyelitis; coagulase-negative staphylococci; follow up; abscess reduction (% volume reduction from diagnosis); linezolid; non-related (death); levofloxacin; PTZ; WBC; clindamycin; cephalo-caudal length in mm; moxifloxacin; computed tomography; SBP; white blood cell; early response; RIF; transversal diameter in mm; PARAV; BOOP; PA; methicillin resistant S. aureus; MOX; vertebral osteomyelitis; PEN; epidural; LEV; Gd; urinary tract infection; ciprofloxacin; chronic obstructive pulmonary disease; Prognosis; Spontaneous; Diseases of the osteoarticular system; Abscess; Rheumatology; Vertebra; Spine disease; Nuclear magnetic resonance imaging; Long term; Spondylitis; Osteitis; Radiology; Medical imagery; Conservative treatment
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/j.semarthrit.2007.08.007

Objectives Management of abscess-associated spontaneous pyogenic vertebral osteomyelitis (PVO) is controversial. The role of magnetic resonance imaging (MRI) in follow-up and its relation with clinical outcome is often unclear. This study evaluates the clinical and MRI outcome of abscess-associated PVO under conservative treatment. Methods Prospective study and retrospective review of patients with spontaneous PVO in whom the initial MRI showed soft-tissue involvement (STI). Treatment according to a medical protocol, clinical and MRI follow-up at diagnosis, and at 2 later time points: early response (ER, at the end of antibiotic therapy) and late response (LR, ≥6 months after therapy). MRI classified STI as soft-tissue edema (STE) or abscess. Results Of the 27 patients (20 men, 74%, age 65 ± 14), all had pain, 17 (63%) had fever, and 6 (22%) had mild neurological impairment. The main etiology was Staphylococcus sp (11, 41%). Twenty-one (81%) had bacteremia and 18 (67%) had epidural/paraspinal abscess. Patients received antibiotics for 9 weeks, administered orally for 6 weeks. ER: Three cases failed and general improvement was seen in the remainder. MRI showed persistent STI, which diminished in all cases except 1, whereas bone/disc findings remained. LR: All patients were cured; 8 reported mild sequelae (30%). MRI still revealed bone/disc abnormalities, but residual STE was infrequent. Median follow-up was 29 months. Conclusion Most patients with abscess-associated spontaneous PVO are cured with a conservative approach. MRI shows STI reduction at ER evaluation. Repeat MRI is probably unnecessary if clinical and laboratory outcomes are satisfactory. The persistence of bone/disc MRI findings alone does not represent therapeutic failure.