Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015;53(6):328-36.
doi: 10.5114/reum.2015.57639. Epub 2016 Feb 11.

Syndromes with chronic non-bacterial osteomyelitis in the spine

Łukasz Kubaszewski  1 , Piotr Wojdasiewicz  2 , Marcin Rożek  3 , Iwona E Słowińska  4 , Katarzyna Romanowska-Próchnicka  5 , Radosław Słowiński  1 , Łukasz A Poniatowski  6 , Robert Gasik  7
Affiliations

Syndromes with chronic non-bacterial osteomyelitis in the spine

Łukasz Kubaszewski et al. Reumatologia. 2015.

Abstract

Chronic non-bacterial osteomyelitis (CNO) has been known for over of 40 years. It is an underrecognized entity due to the low number of described cases and poor propagation awareness of the problem. Chronic non-bacterial osteomyelitis is usually confused with infectious spondylodiscitis or malignant lesions, both primary and metastatic. Failing to consider CNO as one of possible lesions of the spine among an array of differential diagnoses may lead to a prolonged ineffective treatment increasing treatment-related morbidity. In this paper the authors describe these two syndromes, with a possible autoimmune background - chronic recurrent multifocal osteomyelitis (CRMO) and SAPHO syndrome - that include CNO being among the manifestations. The authors present the spinal symptomatology of CNO for both syndromes published so far to help spine clinicians organize the information for better usage in everyday clinical practice.

Keywords: CRMO; SAPHO syndrome; non-bacterial inflammation; osteomyelitis.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Schematic types of radiological changes observed in the vertebral body morphology with the chronic non-bacterial osteomyelitis (CNO).
Fig. 2
Fig. 2
Radiological presentation of mild chronic non-bacterial osteomyelitis (CNO) changes of vertebral bodies. Multi-level affections with end-plate remodeling, sclerotisation and anterior vertebral body height reduction (A). Characteristic vertebral body remodeling with bone hypertrophy and osteophyte formation (B).
Fig. 3
Fig. 3
T2 weighted magnetic resonance images shows typical persistent changes of chronic non-bacterial osteomyelitis (CNO) in thoracic spine. Normal signal intensity of the vertebral bodies with multi-level remodeling of the end-plates.
Fig. 4
Fig. 4
Advanced spondylodiscitis at C6/C7 motion segment with end-plate destruction and local kyphosis (A). T2 weighted magnetic resonance images shows circumstantially, additionally to advanced destruction, abnormal signal in vertebrae suggesting chronic non-bacterial osteomyelitis (CNO) (B).
See this image and copyright information in PMC

References

    1. Takigawa T, Tanaka M, Nakanishi K, et al. SAPHO syndrome associated spondylitis. Eur Spine J. 2008;17:1391–1397. - PMC - PubMed
    1. Kotilainen P, Gullichsen RE, Saario R, et al. Aseptic spondylitis as the initial manifestation of the SAPHO syndrome. Eur Spine J. 1997;6:327–329. - PMC - PubMed
    1. Giedion A, Holthusen W, Masel LF, Vischer D. Subacute and chronic “symmetrical” osteomyelitis. Ann Radiol (Paris) 1972;15:329–342. - PubMed
    1. Sasaki T. A case of osteomyelitis of the bilateral clavicles associated with pustulosis palmaris et plantaris. Rinsho Seikeigeka. 1967;2:333–337.
    1. Ferguson PJ, Sandu M. Current understanding of the pathogenesis and management of chronic recurrent multifocal osteomyelitis. Curr Rheumatol Rep. 2012;14:130–141. - PMC - PubMed

LinkOut - more resources