[Non-tubercular vertebral osteomyelitis: diagnosis and therapy of 45 patients from a single Italian centre]

Abstract

Aim of the study: to evaluate the episodes of non-tubercular spondylodiskitis diagnosed between 1998 and 2002 at the Ospedale S. Corona, Pietra Ligure (SV).

Methods: perspective evaluation of vertebral osteomyelitis classified as spontaneous or iatrogenic if associated with procedures on the spinal cord, with detection of associated risk factors, localization, aetiology and treatment.

Results: 45 episodes, 71% spontaneous and 29% iatrogenic were observed. Associated risk factors were present in 47% of spontaneous spondylodiskitis. Lumbosacral localization was detected in 68% of spontaneous and 100% of iatrogenic episodes. Other localizations in spontaneous spondylodiskitis were dorsal (25%) or cervical (7%). Methicillin-sensitive staphylococci caused the majority of spontaneous spondylodiskitis, while methicillin-resistant strains were more frequently involved in iatrogenic episodes. Among spontaneous spondylodiskitis, 63% healed with antibiotics for 8 weeks, but surgery was often needed in dorsal localizations. In iatrogenic forms antibacterial therapy for 8 weeks-6 months was effective in cases not associated with foreign bodies but their presence always required surgery for healing.

Conclusions: spondylodiskitis is more frequently localized at lumbosacral level. Beta-lactams are generally effective in spontaneous episodes, while iatrogenic ones often require associations of drugs. Surgery may be required in the case of dorsal localization or in the presence of foreign bodies.