Vertebral Osteomyelitis The vertebrae are the most common sites of hematogenous osteomyelitis in adults. Organisms reach the well-perfused vertebral body via spinal arteries and quickly spread from the end plate into the disk space and then to the adjacent vertebral body. Sources of bacteremia include the urinary tract (especially among men over age 50), dental abscesses, soft tissue infections, and contaminated IV lines, but the source of bacteremia is not evident in more than half of patients. Diabetes mellitus requiring insulin injection, a recent invasive medical procedure, hemodialysis, and injection drug use carry an increased risk of spinal infection. Many. | Chapter 120. Osteomyelitis Part 2 Vertebral Osteomyelitis The vertebrae are the most common sites of hematogenous osteomyelitis in adults. Organisms reach the well-perfused vertebral body via spinal arteries and quickly spread from the end plate into the disk space and then to the adjacent vertebral body. Sources of bacteremia include the urinary tract especially among men over age 50 dental abscesses soft tissue infections and contaminated IV lines but the source of bacteremia is not evident in more than half of patients. Diabetes mellitus requiring insulin injection a recent invasive medical procedure hemodialysis and injection drug use carry an increased risk of spinal infection. Many patients have a history of degenerative joint disease involving the spine and some report an episode of trauma preceding the onset of infection. Penetrating injuries and surgical procedures involving the spine may cause nonhematogenous vertebral osteomyelitis or infection localized to a disk. Most patients with vertebral osteomyelitis report neck or back pain patients may describe atypical pain in the chest the abdomen or an extremity that is due to irritation of nerve roots. Symptoms are localized to the lumbar spine more often than to the thoracic spine 50 vs. 35 of cases or the cervical spine in pyogenic infections but the thoracic spine is involved most commonly in tuberculous spondylitis Pott s disease . More than 50 of patients experience a subacute illness in which a vague dull pain gradually intensifies over 2-3 months. Fever is usually low-grade or absent but some patients recall having had an episode of fever and chills prior to or at the onset of pain. An acute presentation with high fever and toxicity is less common and suggests ongoing bacteremia. Percussion over the involved vertebra elicits tenderness and physical examination may reveal spasm of the paraspinal muscles and limitation of motion. Laboratory findings at the time of presentation include a normal or .
