Osteomyelitis

As a benign-appearing lytic lesion

• When bony sequestrum is seen, OM should be strongly considered
  • Only lesions that demonstrate sequestra are infection, Eosinophilic granuloma, lymphoma, and fibrosarcoma

Discriminators

None

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1. Fever, back pain, focal spinal tenderness after UTI suggests vertebral osteomyelitis most likely hematogenous spread
2. Fever present in <50% of cases
3. Exquisite focal tenderness at spinous process; muscle spasm in contiguous area and decreased ROM
4. Epidural abscess may result if infection extends posteriorly into epidural space
5. Workup is CBC, blood culture, ESR/CRP
   1. Leukocytes may be normal but ESR/CRB usually elevated
6. X-ray may show vertebral collapse but often normal in early osteo
7. MRI is imaging modality of choice
8. Radionucleotide bone scan w/ gallium is alternate for pts that can't do MRI
9. CT-guided aspiration and culture of infected intervertebral disc space or bone needed to confirm the dx
   
   See: