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Long-term clinical and radiological (MRI) outcome of abscess-associated spontaneous pyogenic vertebral osteomyelitis under conservative management

Abstract number: 1733_961

Euba G., Narvaez J.A., Nolla J.M., Murillo O., Narvaez J., Gomez C., Ariza J.

Objectives: Spontaneous Pyogenic Vertebral Osteomyelitis (SPVO) is classically considered a medical management disease. Surgical approach is widely accepted for spinal cord compression or vertebral instability, but controversial for abscess-associated SPVO. Magnetic Resonance Imaging (MRI) is the test of choice at diagnosis, most patients (pts) showing Soft Tissue Involvement (STI); it seems also helpful for follow-up, but MRI and clinical outcome interrelation is often unclear. The aim of this study is to evaluate clinical and MRI outcome of SPVO with STI under conservative treatment.

Methods: Prospective study (PS, period 2000–05) and retrospective review (RR, period 1995–99) including pts with SPVO in a 1,000 bed tertiary hospital, treatment according to medical protocol and follow-up evaluation considering clinical, biological and MRI findings at diagnosis, Early Response (ER, end of planned antibiotic therapy) and Late Response (LR, ≥ 6 months from end of therapy). Inclusion criteria: MRI at diagnosis showing STI; follow-up MRI; initial non-surgical approach. MRI images were reviewed by an expert radiologist; STI was classified as inflammatory reaction (IR) or abscess, and abscesses were measured.

Results: Twenty-seven pts (19 PS, 8 RR) were included, 20 men (74%), mean age 65 ± 14. All had pain, 17 (63%) fever and 6 (22%) mild neurological impairment. Main aetiology was Staphylococcus spp. (11, 41%); no microorganism was identified in 4 (22%). Bacteraemia was documented in 21 (81%) and epidural/paraspinal abscess in 18 (67%). Antibiotics were given for median of 9 weeks, orally for 6 weeks. ER: only 3 pts were considered as therapeutic failure (1 underwent laminectomy for paraparesis development; 2 had therapy extended for persistent clinical findings) with good final outcome; clinical and biological improvement was seen in the remainder; MRI showed persistent STI, which diminished in all but 2 pts, whereas bone and disc findings hardly improved or worsened. LR: median follow-up was 29 months, no relapse or related death occurred; all pts were considered clinical and biologically cured, with mild sequels in 8 (pain/dysesthesia); MRI still showed bone/disc abnormalities, but residual IR was infrequent (6 pts).

Conclusion: Most pts with abscess-associated SPVO cure with a medical approach and 8–10 week antibiotic therapy, STI reduction being found in MRI at ER point. Bone/disc MRI worsening alone during follow-up should not suggest therapeutic failure.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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