PYOGENIC, TUBERCULOUS, AND BRUCELLAR VERTEBRAL OSTEOMYELITIS - A DESCRIPTIVE AND COMPARATIVE-STUDY OF 219 CASES

Objectives-To describe a large series of patients with vertebral osteo myelitis (VO), and to compare the clinical, biological, radiological, and prognostic features of pyogenic (PVO), tuberculous (TVO), and bruc ellar vertebral osteomyelitis (BVO). Methods-A retrospective multicent re study, which included 219 adult patients with VO with confirmed aet iology, who were diagnosed between 1983 and 1995 in two tertiary care centres. Of these patients, 105 (48%) had BVO, 72 (33%) PVO, and 42 (1 9%) TVO. Results-One hundred and forty eight (67.6%) patients were mal e and 71 (32.4%) female. The mean (SD) age was 50.4 (16.4) years (rang e 14-84) and the mean (SD) duration of symptoms before the diagnosis w as 14 (16.8) weeks. In 127 patients (57.9%) the vertebral level involv ed was lumbar, in 70 (31.9%) thoracic, and in 16 (7.3%) cervical. One hundred and nineteen patients (54.4%) received only medical treatment and 100 (45.6%) required both medical and surgical treatment. The pres ence of diabetes mellitus, intravenous drug abuse, underlying chronic debilitating diseases or immunosuppression, previous infections, prece eding bacteraemia, recent vertebral surgery, leucocytosis, neutrophili a, and increased erythrocyte sedimentation rate (ESR) were significant ly associated to PVO. A prolonged clinical course, thoracic segment in volvement, absence of fever, presence of spinal deformity, neurologica l deficit, and paravertebral or epidural masses, were significantly mo re frequent in the group of TVO. The need for surgical treatment and t he presence of severe functional sequelae were more frequent in the gr oups of PVO and TVO. Conclusion-There are significant clinical, biolog ical, radiological, and prognostic differences between BVO, PVO, and T VO. These differences can point to the causal agent and orient the ini tial empirical medical treatment white awaiting a final microbiologica l diagnosis.