Tuberculous, Pyogenic, and Brucellar Vertebral Osteomyelitis: A 10-year Experience

Objective: Spinal osteomyelitis is an uncommon cause of back pain but it has potential to compromise nervous system and even death may occur if it is not treated effectively. We compared the underlying diseases, clinical, and complications among patients with pyogenic (PVO), brucellar (BVO), and tuberculous vertebral osteomyelitis (TVO). Patients and Methods: In this descriptive-comparative study, all patients older than 1 year who were hospitalized at Rasoul-e-Akram Hospital from 1999 to 2009 with a confirmed diagnosis of VO were included. The diagnosis of VO was confirmed in the presence of compatible clinical features, vertebral CT scan or MRI. Etiological diagnosis of VO was defined when the microorganism was isolated from blood culture, bone biopsy, paravertebral abscess aspiration; typical histopathological pattern of tuberculosis (caseating granuloma) or malignancy in bone biopsy; Wright’s or serum agglutination test  1/80 or 2ME  1/40 according to the national guidelines. Analytical statistics such as the chi-square and t test were used to find correlation and relationships among the variables. P < 0.05 was considered to indicate statistical significance. Results: A total number of 87 patients studied. There were 62 (71.26%) males and 25 (28.73%) females. Thirty-eight (43.67%) patients had PVO, 26 (29.88%) had TVO, 18 (20.68%) had BVO, 3 (3.4%) had malignant disorder with metastasis to bone, and the remaining 2 (2.29%) cases had fungal VO. Fever and back pain were the most common symptoms in PVO (12), but in TVO the most common symptom was back pain. DM and previous bone spinal surgery were the most common underlying diseases in PVO patients (P=0.000). Paravertebral abscess was reported in 6 (23.7%) patients with TVO and 6 patients (15.78%) with PVO, but no such complication was noted in BVO group. Conclusion: There are significant differences between VO by different microorganisms that help physician to start empirical medical treatment while waiting to definite diagnosis by blood culture, culture from paravertebral abscess, serology and bone biopsy