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Long-term clinical and radiological magnetic resonance imaging outcome of abscess-associated spontaneous pyogenic vertebral osteomyelitis under conservative management.

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.

journal_name

Semin Arthritis Rheum

journal_title

Seminars in arthritis and rheumatism

authors

Euba G,Narváez JA,Nolla JM,Murillo O,Narváez J,Gómez-Vaquero C,Ariza J

doi

10.1016/j.semarthrit.2007.08.007

subject

Has Abstract

pub_date

2008-08-01 00:00:00

pages

28-40

issue

eissn

0049-0172

issn

1532-866X

pii

S0049-0172(07)00143-6

journal_volume

pub_type

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Long-term clinical and radiological magnetic resonance imaging outcome of abscess-associated spontaneous pyogenic vertebral osteomyelitis under conservative management.