VERTEBRAL OSTEOMYELITIS AT A NORWEGIAN UNIVERSITY HOSPITAL 1987-97 - CLINICAL-FEATURES, LABORATORY FINDINGS AND OUTCOME

Altogether 40 patients aged 13-91 y (average 58 y) with vertebral oste omyelitis mere treated at the Bergen University Hospital between July 1987 and June 1997. All patients presented with back pain, 33 (83%) ha d vertebral tenderness, and 26 (65%) patients were febrile. The durati on of symptoms before diagnosis was < 3 weeks in 13 patients, and from 3 to 16 weeks in the remaining 27 patients. C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) were elevated in 39 and 38 patients, respectively. Staphylococcus aureus was the most frequen t cause of osteomyelitis followed by Streptococcus spp., Escherichia c oli and Mycobacterium tuberculosis. Magnetic resonance imaging was sup erior to other radiological methods and demonstrated changes consisten t with osteomyelitis in all 23 patients examined with this method. 35 patients survived. 18/35 surviving patients had pareses and 17 underwe nt surgery with drainage of abscesses or laminectomy. All 35 patients made a good recovery and only 3 patients experienced permanent pareses . The diagnosis of vertebral osteomyelitis is easily missed, and treat ment is often delayed, particularly in the elderly in whom signs of se psis mau not manifest. However, persisting localized pain and tenderne ss over the spine together with elevated CRP and ESR should prompt the physician to consider vertebral osteomyelitis. Fever and leukocytosis may support the diagnosis, but may not always be present.