Objective The records of 62 patients with clinical and radiographic evidenc
e of vertebral osteomyelitis and positive bacteriological diagnosis, seen b
etween 1979 and 1996 were reviewed in order to gather data on the epidemiol
ogy and the clinical pattern displayed by patients with this condition in n
orthern Spain.
Results Staphylococcus aureus (15 cases), Mycobacterium tuberculosis (15 ca
ses) and Brucella melitensis (13 cases) were the microorganisms most freque
ntly found in our patient series. After improvement of the sanitary and hyg
ienic control of food products, the role of Brucella melitensis is decreasi
ng as a causative agent (only 3 cases in the last 6 years). Stapylococcus e
pidermidis, present in 4 cases (6.6%), should be suspected in elderly patie
nts with previous intravenous cannulations (3 of 4 cases). The most frequen
t risk factors were alcoholism (7 cases), chronic hepatic disease (7 cases)
, diabetes (6 cases) and previous surgery (6 cases). Delay in diagnosis was
high (the mean number of days between the onset of symptoms and diagnosis
was 125). The lumbar region was the most commonly affected site. Neurologic
involvement was present in 10 patients on admission (16%). ESR was > 50 mm
/hr in a high number of cases. Blood cultures were found to be the most val
uable routine test. Plain x-rays were normal in 10 patients (16%); in 6 of
them Staphylococcus aureus was the responsible organism. Other imaging moda
lities showed a high sensitivity. Surgical drainage was necessary in 12 ind
ividuals (in 7 due to Mycobacterium tuberculosis). Outcome was good in the
majority of cases: only 2 patients with associated endocarditis died. Neuro
logic sequelae were present in another 3 patients.
Conclusion Vertebral osteomyelitis can be caused by a variety of pathogens.
Therefore, bacteriological studies are necessary to establish the etiologi
c diagnosis and determine the specific antimicrobial treatment required.