Author(s): Euba G, Narvez JA, Nolla JM, Murillo O, Narvez J,
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Abstract 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, >or=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.
This article was published in Semin Arthritis Rheum
and referenced in Journal of Addiction Research & Therapy