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

Semin Arthritis Rheum. 2008 Aug;38(1):28-40. doi: 10.1016/j.semarthrit.2007.08.007. Epub 2007 Dec 11.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abscess / diagnosis
  • Abscess / drug therapy*
  • Adult
  • Aged
  • Aged, 80 and over
  • Epidural Abscess / diagnosis
  • Epidural Abscess / drug therapy
  • Female
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Osteomyelitis / diagnosis
  • Osteomyelitis / diet therapy*
  • Spine*