Vertebral osteomyelitis; methods for diagnosis and means of treatment

ABSTRACT

Vertebral osteomyelitis is an uncommon illness; adults are mostly affected. Our objective is to evaluate the short term outcome of oral versus parenteral antimicrobials treatment for pyogenic [nontuberculous and non-brucellosis] vertebral osteomyelitis, and the best invasive diagnostic method yielding a microbiological diagnosis. The medical records were reviewed in a retrospective study for patients >/- 18 years old from five urban hospitals within Amman-Jordan; two teaching and three primary care hospitals, during the period between August 1999 to June 2007. Due to the small numbers in the arm of antimicrobials treatment, tstudents' test was used to assess inferences like 95% confidence interval and p-values for the difference among treatment arms. Seventy-four medical records were available, inpatients records 35 from two teaching hospitals, 39 records from three primary care hospitals. The orally treated patients showed lack of difference against the parenteral therapy group at the end of 6 weeks therapy [p > 0.05]. Diagnostic methods tested for microbiological diagnosis were as follows; True cut biopsy, fine needle aspiration and limited laminectomy did not differ significantly in their microbiological diagnostic ability. Our data suggested lack of difference between oral and parenteral therapy groups at the end of six weeks treatment, but a questionable tendency [95% CI; -0.11 to 0.64, p= 0.08]. The diagnostic ability of the three methods did not suggest significant differences [p >0.05], except for true cut biopsy versus fine needle aspiration where it showed tendency [95% CI; - 0.20 to 0.42, p= 0.07]. The key to successful management is the early diagnosis, and bone sampling for microbiological examination, allowing proper antimicrobial selection. A proper bone sampling method is important to evaluate, especially in the absence of surgical indication and the co-notation in some parts of the world that M. tuberculosis is the most -if not the sole- pathogen in vertebral osteomyelitis