Extended reports
Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a
descriptive and comparative study of 219 cases
a Unit of Infectious Diseases, University
Regional Hospital "Carlos Haya", Málaga, Spain, b Unit of Infectious Diseases, University Hospital
"Virgen del Rocío", Seville, Spain
Correspondence to: Dr JD Colmenero, Unit of Infectious Diseases, Internal Medicine Department, Hospital Regional de Málaga, Camino de Antequera s/n, 29010 Málaga, Spain.
Accepted for publication 1 October 1997
OBJECTIVES
To describe a large series of patients
with vertebral osteomyelitis (VO), and to compare the clinical,
biological, radiological, and prognostic features of pyogenic (PVO),
tuberculous (TVO), and brucellar vertebral osteomyelitis (BVO).
METHODSA retrospective multicentre study, which
included 219 adult patients with VO with confirmed aetiology, who were
diagnosed between 1983 and 1995 in two tertiary care centres. Of these
patients, 105 (48%) had BVO, 72 (33%) PVO, and 42 (19%) TVO.
RESULTSOne hundred and forty eight (67.6%)
patients were male and 71 (32.4%) female. The mean (SD) age was 50.4 (16.4) years (range 14-84) and the mean (SD) duration of symptoms
before the diagnosis was 14 (16.8) weeks. In 127 patients (57.9%) the
vertebral level involved was lumbar, in 70 (31.9%) thoracic, and in 16 (7.3%) cervical. One hundred and nineteen patients (54.4%) received
only medical treatment and 100 (45.6%) required both medical and
surgical treatment. The presence of diabetes mellitus, intravenous
drug abuse, underlying chronic debilitating diseases or
immunosuppression, previous infections, preceeding bacteraemia, recent
vertebral surgery, leucocytosis, neutrophilia, and increased
erythrocyte sedimentation rate (ESR) were significantly associated to
PVO. A prolonged clinical course, thoracic segment involvement, absence of fever, presence of spinal deformity, neurological deficit, and
paravertebral or epidural masses, were significantly more frequent in
the group of TVO. The need for surgical treatment and the presence of
severe functional sequelae were more frequent in the groups of PVO and TVO.
CONCLUSIONThere are significant clinical,
biological, radiological, and prognostic differences between BVO, PVO,
and TVO. These differences can point to the causal agent and orient the
initial empirical medical treatment while awaiting a final
microbiological diagnosis.
© 1997 by Annals of the Rheumatic Diseases
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