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
Review
. 2024 Sep 28;13(19):5802.
doi: 10.3390/jcm13195802.

Culture-Negative Native Vertebral Osteomyelitis: A Narrative Review of an Underdescribed Condition

Seyed Mohammad Amin Alavi  1 , Francesco Petri  2   3 , Omar K Mahmoud  2 , Rita Igwilo-Alaneme  2 , Said El Zein  2 , Ahmad N Nassr  4 , Andrea Gori  3   5 , Elie F Berbari  2
Affiliations
Review

Culture-Negative Native Vertebral Osteomyelitis: A Narrative Review of an Underdescribed Condition

Seyed Mohammad Amin Alavi et al. J Clin Med. .

Abstract

The incidence of culture-negative NVO (CN-NVO) cases is increasing, presenting significant diagnostic and therapeutic challenges due to the inability to isolate causative organisms with conventional microbiological methods. Factors influencing the diagnosis of CN-NVO include prior antimicrobial therapy, low pathogen burden, fastidious or intracellular organisms, technical issues, and non-infectious mimickers. Diagnosis often relies on imaging modalities like magnetic resonance imaging (MRI) and computed tomography (CT)-guided biopsy, though these methods can sometimes fail to yield positive microbiological results. Advanced diagnostic tools, such as polymerase chain reaction (PCR), metagenomic next-generation sequencing (mNGS), and cell-free DNA analysis, may be necessary to identify the pathogen. The causative pathogen cannot be isolated in some patients, among which an empirical antimicrobial therapy should be initiated. This narrative review discusses the management, monitoring, surgical indications, and outcomes for patients with CN-NVO.

Keywords: diagnosis; discitis; management; negative culture; spondylitis; vertebral osteomyelitis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The approach for diagnosis of native vertebral osteomyelitis.
Figure 2
Figure 2
The approach of surgical intervention for the management of culture-negative vertebral osteomyelitis (CN-NVO).
See this image and copyright information in PMC

References

    1. Dogan M., Simsek A.T., Yilmaz I., Karaarslan N. Evaluation of Empirical Antibiotic Treatment in Culture Negative Pyogenic Vertebral Osteomyelitis. Turk. Neurosurg. 2019;29:816–822. doi: 10.5137/1019-5149.JTN.25018-18.2. - DOI - PubMed
    1. Maamari J., Tande A.J., Diehn F., Tai D.B.G., Berbari E.F. Diagnosis of Vertebral Osteomyelitis. J. Bone Jt. Infect. 2022;7:23–32. doi: 10.5194/jbji-7-23-2022. - DOI - PMC - PubMed
    1. Issa K., Diebo B.G., Faloon M., Naziri Q., Pourtaheri S., Paulino C.B., Emami A. The Epidemiology of Vertebral Osteomyelitis in the United States from 1998 to 2013. Clin. Spine Surg. 2018;31:E102–E108. doi: 10.1097/BSD.0000000000000597. - DOI - PubMed
    1. Thavarajasingam S.G., Vemulapalli K.V., Vishnu K.S., Ponniah H.S., Vogel A.S.-M., Vardanyan R., Neuhoff J., Kramer A., Shiban E., Ringel F., et al. Conservative versus Early Surgical Treatment in the Management of Pyogenic Spondylodiscitis: A Systematic Review and Meta-Analysis. Sci. Rep. 2023;13:15647. doi: 10.1038/s41598-023-41381-1. - DOI - PMC - PubMed
    1. Maamari J., Grach S.L., Passerini M., Kinzelman-Vesely E.A., Nassr A., Carr C., Diehn F.E., Tande A.J., Murad M.H., Berbari E.F. The Use of MRI, PET/CT, and Nuclear Scintigraphy in the Imaging of Pyogenic Native Vertebral Osteomyelitis: A Systematic Review and Meta-Analysis. Spine J. 2023;23:868–876. doi: 10.1016/j.spinee.2023.01.019. - DOI - PubMed

LinkOut - more resources