This 2016 narrative review by Cornett et al. synthesizes the pathophysiology, diagnosis, and management of bacterial spinal infections in adults — vertebral osteomyelitis, discitis, and epidural abscess — addressing when to image, when to biopsy, when to operate, and how long to treat.
When you see a patient with back or neck pain and any immunocompromising risk factor — IV drug use, diabetes, dialysis, recent instrumentation — maintain a high index of suspicion for spinal infection, hold antibiotics if the patient is stable, and get MRI with gadolinium first; surgical intervention is warranted when neurologic deficits are present or evolving, when medical management fails, or when spinal instability develops.
This 2016 narrative review by Cornett et al. synthesizes the pathophysiology, diagnosis, and management of bacterial spinal infections in adults — vertebral osteomyelitis, discitis, and epidural abscess — addressing when to image, when to biopsy, when to operate, and how long to treat.
When you see a patient with back or neck pain and any immunocompromising risk factor — IV drug use, diabetes, dialysis, recent instrumentation — maintain a high index of suspicion for spinal infection, hold antibiotics if the patient is stable, and get MRI with gadolinium first; surgical intervention is warranted when neurologic deficits are present or evolving, when medical management fails, or when spinal instability develops.