Diagnosing and treating native spinal and pelvic osteomyelitis in adolescents
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CASE SERIES
Diagnosing and treating native spinal and pelvic osteomyelitis in adolescents Lara L. Cohen1 · Benjamin J. Shore1,2 · Kathryn A. Williams1 · Daniel J. Hedequist1,2 · M. Timothy Hresko1,2 · John B. Emans1,2 · Lawrence I. Karlin1,2 · Brian D. Snyder1,2 · Michael P. Glotzbecker1,2 Received: 23 January 2020 / Accepted: 25 March 2020 © Scoliosis Research Society 2020
Abstract Study design Retrospective case series. Objectives To describe how pediatric patients with spinal and pelvic osteomyelitis are diagnosed and treated and assess the diagnostic value of magnetic resonance imaging (MRI), needle aspiration biopsy (NAB), and blood cultures in this population. Summary of background data Spinal and pelvic osteomyelitis de novo are uncommon in children and minimal literature exists on the subject. Research has shown that NAB and blood cultures have variable diagnostic yield in adult native osteomyelitis. At our institution, there is no standard protocol for diagnosing and treating pediatric spinal and pelvic osteomyelitis de novo. Methods All diagnoses of spinal and pelvic osteomyelitis at a pediatric tertiary care center from 2003 to 2017 were reviewed. Patients aged 0–21 at diagnosis were included. Patients with osteomyelitis resulting from prior spinal operations, wounds, or infections and those with chronic recurrent multifocal osteomyelitis were eliminated. All eligible patients’ diagnoses were confirmed by MRI. Results 29 patients (18 men, 11 women) met the inclusion criteria. The median age at diagnosis was 11 years old (range 1–18). More than half of all cases (17/29, 59%) affected the lumbar spine. The most common symptoms were back pain (20/29, 69%), fever (18/29, 62%), hip pain (11/29, 38%), and leg pain (8/29, 28%). The majority of NABs and blood cultures performed were negative, but of the positive tests Staphylococcus aureus was the most prevalent bacteria. 86% (25/29) had an MRI before a diagnosis was made and 72% (13/18) had an NAB performed post-diagnosis. Conclusions MRI is a popular and helpful tool in diagnosing spinal osteomyelitis de novo. NAB cultures are often negative but can be useful in determining antibiotic treatment. Level of evidence Level IV. Keywords Osteomyelitis · Pediatric orthopedics · Spinal infection · Magnetic resonance imaging · Needle aspiration biopsy
Introduction Vertebral osteomyelitis, also known as spinal osteomyelitis, typically occurs as pyogenic osteomyelitis in adults over 50 years old [1]. Vertebral osteomyelitis can be acute, subacute, or chronic and is commonly caused by Pseudomonas * Michael P. Glotzbecker [email protected] 1
Department of Orthopedic Surgery, Boston Children’s Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA 02115, USA
Harvard Medical School, Boston, MA, USA
2
aeruginosa, Staphylococcus species, Mycobacterium tuberculosis, or Escherichia coli pathogens [2–5]. Vertebral osteomyelitis initially presents with back pain and is frequently located in the lumbar spine in most adults [5, 6]. In sev
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