Spinal Osteomyelitis

HPI

Important details for HPI:

• Duration of symptoms? Time to presentation?
• Exposure?
• Recent invasive procedure [surgery, colonoscopy, dental work]
• Infection (UTI, bacteremia, cellulitis)
• Immunocompromised (steroids, chemo, immunosuppressants, HIV)
• ROS to identify common concomitant infections (UTI, pneumonia, endocarditis, septic arthritis, cellulitis, psoas abscess)

Descriptors

• Spinal level? Number of levels involved?
• Kyphosis?
• Associated epidural abscess?
• Concomitant area of infection outside spine and paraspinal region?

Exam Pearls

Spine exam

If neuro deficit - classify with the ASIA scale

Long tract signs: Hoffman, clonus

Workup

Radiographs:
Standing radiographs of the area (e.g. AP/lateral XR of the lumbar spine)

Other imaging:
MRI with and without contrast of the entire spine (total spine needed to assess for skip lesions).

Epidural abscess workup if associated epidural abscess.

Labs:
CBC w/ diff, LFTs, BMP
ESR, CRP
Blood cultures (obtain prior to antibiotics)
Evaluate for other sources as needed (UA/CXR)

Other:
Preoperative workup if operative

Management

Need for acute intervention:
None usually indicated

Weight-bearing and range of motion:
Activity as tolerated

Type of immobilization:
None unless concomitant instability or fracture

Admission or discharge status:
Admit to medicine for multidisciplinary care

Anticoagulation:
None

Antibiotics:
Broad spectrum antibiotics ID consult IR biopsy to guide therapy Hold antibiotics if HDS until IR biopsy

Surgical Indications

Absolute:
Progressive neurologic deficit Instability Failure of IV antibiotics to resolve infection

Relative:
Alignment

Not an indication:
Pain