Pyogenic vertebral osteomyelitis presenting as single spinal compression fracture: a case report and review of the literature

Study design: A case report of pyogenic vertebral osteomyelitis (PVO) prese nting as single collapsed vertebral body without narrowing of the intervert ebral disc space, and review of the literature. Objective: To describe an unusual case of PVO showing atypical radiological change and call attention to this condition so that others may avoid this diagnostic pitfall. Setting: Japan. Methods: A 62-year-old diabetic woman with suspected T12 pa thological fracture of malignant spinal tumor and neurological involvement received urgent anterior decompression and spinal reconstruction without bi opsy. Results: Anterior decompression and spinal reconstruction was performed, bu t histological examination of the specimen after surgery unexpectedly revea led PVO. The surgery was followed by therapy with antibiotics for 7 months. A follow-up radiograph at 5 years after surgery revealed that solid consol idation has been achieved. Conclusions: Diagnosis of PVO presenting with single spinal compression fra cture is very difficult. Although the finding of the high signal intensity in the lesion equal to or higher than that of the cerebrospinal fluid on T2 -weighted MR image seemed to be the most reliable diagnostic modality retro spectively, diagnosis of this type of PVO is impossible without histology. A needle biopsy before surgery is strongly recommended.