Risk factors and prognosis of vertebral compressive fracture in pyogenic vertebral osteomyelitis

Older patients with pyogenic vertebral osteomyelitis (PVO) usually have more medical comorbidities compared with younger patients, and present with advanced infections from different causative organisms. To aid surgical decision-making, we compared surgical outcomes of older patients with PVO to those who underwent nonoperative treatment. We identified the risk factors for adverse post-operative outcomes, and analyzed the clinical risks from further spinal instrumentation. This retrospective comparative study included 439 patients aged ≥75 years with PVO. Multivariable analysis was performed to compare treatment outcomes among three groups: 194, 130, and 115 patients in the non-operative, non-instrumented, and instrumented groups, respectively. The risk factors for adverse outcomes after surgical treatment were evaluated using a logistic regression model, and the estimates of the multivariable models were internally validated using bootstrap samples. Recurrence and mortality of these patients were closely associated with neurologic deficits, and increased surgical invasiveness, resulting from additional spinal instrumentation, did not increase the risk of recurrence or mortality. We propose that surgical treatment for these patients should focus on improving neurologic deficits through immediate and sufficient removal of abscesses. Spinal instrumentation can be performed if indicated, within reasonable clinical risk.

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P108. Anterior Allograft Bone Dowel Treatment of Pyogenic Vertebral Osteomyelitis

The Spine Journal ◽

10.1016/j.spinee.2006.06.317 ◽

2006 ◽

Vol 6 (5) ◽

pp. 135S-136S

Author(s):

Michael Dabbah ◽

Justin Tortolani ◽

Ira L. Fedder ◽

Farhan Siddiqi ◽

Victor Hayes ◽

...

Keyword(s):

Vertebral Osteomyelitis ◽

Allograft Bone ◽

Pyogenic Vertebral Osteomyelitis

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Percutaneous Drainage Followed by Antibiotic-Impregnated Cement Vertebroplasty for Pyogenic Vertebral Osteomyelitis: A Case Report

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e318160f72b ◽

2008 ◽

Vol 64 (1) ◽

pp. E8-E11 ◽

Cited By ~ 5

Author(s):

Lih-Huei Chen ◽

Shih-Chjeh Yang ◽

Chi-Chien Niu ◽

Po-Liang Lai ◽

Wen-Jer Chen

Keyword(s):

Case Report ◽

Percutaneous Drainage ◽

Vertebral Osteomyelitis ◽

Pyogenic Vertebral Osteomyelitis

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A surgical case of bilateral acute empyema due to pyogenic vertebral osteomyelitis

The Journal of the Japanese Association for Chest Surgery ◽

10.2995/jacsurg.34.364 ◽

2020 ◽

Vol 34 (5) ◽

pp. 364-369

Author(s):

Akihiro Yonei ◽

Hirokazu Moriyama

Keyword(s):

Vertebral Osteomyelitis ◽

Surgical Case ◽

Acute Empyema ◽

Pyogenic Vertebral Osteomyelitis

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Hospital mortality in hematogenous vertebral osteomyelitis

Hirurgiâ pozvonočnika ◽

10.14531/ss2021.3.86-93 ◽

2021 ◽

Vol 18 (3) ◽

pp. 86-93

Author(s):

A. Yu. Bazarov ◽

K. S. Sergeyev ◽

A. O. Faryon ◽

R. V. Paskov ◽

I. A. Lebedev

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Hospital Mortality ◽

Medical Records ◽

Vertebral Osteomyelitis ◽

Hospital Death ◽

Factors Affecting ◽

Comorbidity Index ◽

Probability Of Death ◽

Type C

Objective. To analyze lethal outcomes in patients with hematogenous vertebral osteomyelitis.Material and Methods. Study design: retrospective analysis of medical records. A total of 209 medical records of inpatients who underwent treatment for hematogenous vertebral osteomyelitis in 2006–2017 were analyzed. Out of them 68 patients (32.5 %) were treated conservatively, and 141 (67.5 %) – surgically. The risk factors for lethal outcomes were studied for various methods of treatment, and a statistical analysis was performed.Results. Hospital mortality (n = 9) was 4.3 %. In patients who died in hospital, average time for diagnosis making was 4 times less (p = 0.092). The main factors affecting mortality were diabetes mellitus (p = 0.033), type C lesion according to the Pola classification (p = 0.014) and age over 70 years (p = 0.006). To assess the relationship between hospital mortality and the revealed differences between the groups, a regression analysis was performed, which showed that factors associated with mortality were Pola type C.4 lesions (OR 9.73; 95 % CI 1.75–54.20), diabetes mellitus (OR 5.86; 95 % CI 1.14–30.15) and age over 70 years (OR 12.58; 95 % CI 2.50–63.34). The combination of these factors increased the likelihood of hospital mortality (p = 0.001). Sensitivity (77.8 %) and specificity (84.2 %) were calculated using the ROC curve. In the group with mortality, the comorbidity index (CCI) was significantly higher (≥4) than in the group without mortality (p = 0.002). With a CCI of 4 or more, the probability of hospital death increases significantly (OR 10.23; 95 % CI 2.06–50.82), p = 0.005. Long-term mortality was 4.3 % (n = 9), in 77.8 % of cases the cause was acute cardiovascular pathology, and no recurrence of vertebral osteomyelitis was detected.Conclusion. Hospital mortality was 4.3 %, and there was no mortality among patients treated conservatively. The main risk factors were diabetes mellitus, type C lesion according to Pola and age over 70 years. There was a significant mutual burdening of these factors (p = 0.001). With CCI ≥4, the probability of death is higher (p = 0.005).

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Epidemiology, Microbiological Diagnosis, and Clinical Outcomes in Pyogenic Vertebral Osteomyelitis: A 10-year Retrospective Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy037 ◽

2018 ◽

Vol 5 (3) ◽

Cited By ~ 18

Author(s):

Brian S W Chong ◽

Christopher J Brereton ◽

Alexander Gordon ◽

Joshua S Davis

Keyword(s):

Cohort Study ◽

Clinical Outcomes ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Vertebral Osteomyelitis ◽

Index Admission ◽

Causative Organism ◽

Microbiological Diagnosis ◽

Treatment Pathways ◽

Pyogenic Vertebral Osteomyelitis

Abstract Background Pyogenic vertebral osteomyelitis (PVO) is rising in incidence, but optimal methods of investigation and duration of antibiotic therapy remain controversial. Methods We conducted a single-center retrospective cohort study of PVO at an Australian teaching hospital. We included all adults with a first episode of PVO between 2006 and 2015. PVO was defined based on the presence of prespecified clinical and radiological criteria. The main exposures of interest were investigation strategy and antibiotic treatment. The main outcome measures were duration of hospital admission, mortality during index admission, symptom resolution during index admission, and attributable readmission within 2 years. Results Of 129 included patients, 101 (78%) had a causative organism identified. Patients with an identified pathogen were more likely to be febrile (75% compared with 29%, P < .001) and had a higher mean admission C-reactive protein (207 vs 54, P < .001) compared with patients without an identified pathogen. However, they were less likely to experience an adverse outcome (death or attributable readmission within 2 years; adjusted odds ratio, 0.36; 95% confidence interval, 0.13–0.99; P = .04). Open biopsy of vertebral tissue had a higher diagnostic yield (70%) than fine needle aspirate (41%) or core biopsy (30%). Despite receiving a median of 6 weeks of intravenous antibiotics, only 15% of patients had a full recovery on discharge from index admission. Conclusions Clinical outcomes for patients with PVO were poor. Obtaining a microbiological diagnosis is associated with a better outcome. However, prospective and randomized studies are essential to establishing optimal investigation and treatment pathways.

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