Cervical Osteomyelitis: A Brief Review

Bryan Barnes, M.D.; Joseph T. Alexander, M.D.; Charles L. Branch Jr., M.D.

Disclosures

Neurosurg Focus. 2004;17(6) 

In This Article

Abstract and Introduction

Object: The authors conducted a literature-based review of the etiology, diagnosis, and treatment of cervical vertebral osteomyelitis (CVO).
Methods: A Medline (PubMed) search using the key words "cervical vertebral osteomyelitis" yielded 256 articles. These were further screened for relevance, yielding 15 articles. Each publication was reviewed, and several others not identified in the PubMed search were screened and included in the review according to relevance. Each article was identified as involving either the epidemiology/etiology, diagnosis, or treatment of CVO. Separate categories were created for case reports and general reviews.
Conclusions: Cervical vertebral osteomyelitis has a spectrum of origins, which include spontaneous, postoperative, traumatic, and hematogenously spread causes. The majority of patients have medical risk factors and comorbidities that include diabetes, trauma, drug abuse, and infectious processes in extraspinal areas. The diagnosis of CVO can be accomplished in most cases by using plain x-ray films and computerized tomography scans. Nevertheless, preferential use of magnetic resonance imaging in cases in which there is a neurological deficit is helpful in identifying epidural compressive processes. Treatment for CVO can be successfully initiated with intravenous antibiotic therapy. Nevertheless, in cases in which there is a neurological deficit, spinal deformity and/or progressive lysis, or intractable pain, the earliest feasible surgical intervention with debridement and fusion is warranted.

Surgical experience with spinal osteomyelitis dates to the early 20th century, when Hibbs[5] performed wiring of the lumbar spinous processes to treat Pott disease, or tuberculosis of the spine. In subsequent decades, spinal surgery techniques that had been developed to treat spinal osteomyelitis were expanded to treat degenerative spine disease. Degenerative spine disease and acute trauma now represent a majority of the spine surgeon's practice. Spinal osteomyelitis still represents a less frequently encountered but nevertheless difficult challenge for the spine surgeon. Cervical osteomyelitis in particular can have potentially catastrophic implications for the patient if not diagnosed and treated early. Based on our review of the available literature on cervical osteomyelitis, we discuss the key elements of diagnosis and management of the disease.

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