Osteomyelitis Of Spine Research Articles

Cervical osteomyelitis in the setting of multiple comorbidities: a complex anatomical approach. Illustrative case.

Vertebral osteomyelitis (VO), also known as spinal osteomyelitis or spondylodiscitis, is a rather rare yet serious disease comprising 3%-5% of all osteomyelitis cases, with only 3%-6% of this subset affecting the cervical spine. Risk factors include an advanced age, diabetes, immunosuppression, and intravenous (IV) drug use. The incidence of VO has increased over recent decades, with high-risk patients experiencing higher mortality rates. Treatment guidelines for VO are not standardized and rely on physician preference, often starting with IV antibiotics and progressing to surgery, if necessary. A 54-year-old female with tracheostomy-dependent obesity hypoventilation syndrome, hypertension, and morbid obesity presented with upper back pain after a fall. Imaging revealed early C6-7 discitis osteomyelitis, which was initially managed conservatively with IV antibiotics. Her condition worsened, leading to anterior corpectomy of C6-7, followed by posterior cervical fusion from C5 to T2 in the sitting position. This approach was chosen due to the patient's complex anatomy and tracheostomy. This case underscores the need for unique surgical approaches in high-risk patients with complex anatomy. It highlights the importance of interdisciplinary care when managing VO, especially in patients with multiple comorbidities. Given the increasing rates of morbid obesity, this case provides valuable insights for neurosurgical decision-making in similar future cases. https://thejns.org/doi/10.3171/CASE24448.

The State-of-the-Art of Mycobacterium chimaera Infections and the Causal Link with Health Settings: A Systematic Review.

(1) Background. A definition of healthcare-associated infections is essential also for the attribution of the restorative burden to healthcare facilities in case of harm and for clinical risk management strategies. Regarding M. chimaera infections, there remains several issues on the ecosystem and pathogenesis. We aim to review the scientific evidence on M. chimaera beyond cardiac surgery, and thus discuss its relationship with healthcare facilities. (2) Methods. A systematic review was conducted on PubMed and Web of Science on 7 May 2024 according to PRISMA 2020 guidelines for reporting systematic reviews, including databases searches with the keyword "Mycobacterium chimaera". Article screening was conducted by tree authors independently. The criterion for inclusion was cases that were not, or were improperly, consistent with the in-situ deposition of aerosolised M. chimaera. (3) Results. The search yielded 290 eligible articles. After screening, 34 articles (377 patients) were included. In five articles, patients had undergone cardiac surgery and showed musculoskeletal involvement or disseminated infection without cardiac manifestations. In 11 articles, respiratory specimen reanalyses showed M. chimaera. Moreover, 10 articles reported lung involvement, 1 reported meninges involvement, 1 reported skin involvement, 1 reported kidney involvement after transplantation, 1 reported tendon involvement, and 1 reported the involvement of a central venous catheter; 3 articles reported disseminated cases with one concomitant spinal osteomyelitis. (4) Conclusions. The scarce data on environmental prevalence, the recent studies on M. chimaera ecology, and the medicalised sample selection bias, as well as the infrequent use of robust ascertainment of sub-species, need to be weighed up. The in-house aerosolization, inhalation, and haematogenous spread deserve experimental study, as M. chimaera cardiac localisation could depend to transient bacteraemia. Each case deserves specific ascertainment before tracing back to the facility, even if M. chimaera represents a core area for healthcare facilities within a framework of infection prevention and control policies.

Ongoing decision-making dilemma for treatment of de novo spinal infections: a comparison of the Spinal Infection Treatment Evaluation Score with the Spinal Instability Spondylodiscitis Score and Spine Instability Neoplastic Score.

De novo spinal infections are an increasing medical problem. The decision-making for surgical or nonsurgical treatment for de novo spinal infections is often a non-evidence-based process and commonly a case-by-case decision by single physicians. A scoring system based on the latest evidence might help improve the decision-making process compared with other purely radiology-based scoring systems or the judgment of a single senior physician. Patients older than 18 years with an infection of the spine who underwent nonsurgical or surgical treatment between 2019 and 2021 were identified. Clinical data for neurological status, pain, and existing comorbidities were gathered and transferred to an anonymous spreadsheet. Patients without an MR image and a CT scan of the affected spine region were excluded from the investigation. A multidisciplinary expert panel used the Spine Instability Neoplastic Score (SINS), Spinal Instability Spondylodiscitis Score (SISS), and Spinal Infection Treatment Evaluation Score (SITE Score), previously developed by the authors' group, on every clinical case. Each physician of the expert panel gave an individual treatment recommendation for surgical or nonsurgical treatment for each patient. Treatment recommendations formed the expert panel opinion, which was used to calculate predictive validities for each score. A total of 263 patients with spinal infections were identified. After the exclusion of doubled patients, patients without de novo infections, or those without CT and MRI scans, 123 patients remained for the investigation. Overall, 70.70% of patients were treated surgically and 29.30% were treated nonoperatively. Intraclass correlation coefficients (ICCs) for the SITE Score, SINS, and SISS were 0.94 (95% CI 0.91-0.95, p < 0.01), 0.65 (95% CI 0.91-0.83, p < 0.01), and 0.80 (95% CI 0.91-0.89, p < 0.01). In comparison with the expert panel decision, the SITE Score reached a sensitivity of 96.97% and a specificity of 81.90% for all included patients. For potentially unstable and unstable lesions, the SISS and the SINS yielded sensitivities of 84.42% and 64.07%, respectively, and specificities of 31.16% and 56.52%, respectively. The SITE Score showed higher overall sensitivity with 97.53% and a higher specificity for patients with epidural abscesses (75.00%) compared with potentially unstable and unstable lesions for the SINS and the SISS. The SITE Score showed a significantly higher agreement for the definitive treatment decision regarding the expert panel decision, compared with the decision by a single physician for patients with spondylodiscitis, discitis, or spinal osteomyelitis. The SITE Score shows high sensitivity and specificity regarding the treatment recommendation by a multidisciplinary expert panel. The SITE Score shows higher predictive validity compared with radiology-based scoring systems or a single physician and demonstrates a high validity for patients with epidural abscesses.

Rare Case of Wide Spread Fungal Spinal Osteomyelitis with Severe Back Pain under Conservative Treatment. Case Report and Review of the Literature

Rare Case of Wide Spread Fungal Spinal Osteomyelitis with Severe Back Pain under Conservative Treatment. Case Report and Review of the Literature

68. Beta lactam resistant staphylococcus aureus in spinal osteomyelitis and spondylodiscitis: trends in antibiotic resistance, treatment, and complications

68. Beta lactam resistant staphylococcus aureus in spinal osteomyelitis and spondylodiscitis: trends in antibiotic resistance, treatment, and complications

DIAGNOSIS AND TREATMENT SPONDYLODISCITIS : THE LITERATURE REVIEW

In many regions of the globe, pyogenic spondylitis remains a significant concern. It is a disorder that affects a very small proportion of the population, but it can be quite severe and even fatal. Frequently, it is difficult to make a diagnosis due to the absence of evident signs or symptoms. It encompasses a vast array of clinical entities, including pyogenic spondylodiscitis, discitis, vertebral osteomyelitis, and spinal osteomyelitis, among others. The success rates of conservative treatment are comparable to those of surgical treatment, but complications and mortality rates are lower. In the absence of a clear indication for surgical intervention, conservative treatment should be considered first. Patients with cervical tract or tuberculous spondylodiscitis should endure closer diagnostic and clinical monitoring due to the increased risk of developing bone collapse and neurological deficits.

Clinical Characteristics of 96 Patients Presenting With Hematogenous Spinal Osteomyelitis- a Retrospective Study.

To report clinical characteristics and course of care for patients diagnosed with hematogenous spinal osteomyelitis (HVO). Medical records of patients presenting to two tertiary care centers with HVO were reviewed. 96 consecutive patients with HVO were identified. Mean follow-up was 8.9months. Most infections occurred in the lumbar region (50.0%). Of the cultures taken, MRSA accounted for 9%; MSSA, 26%; Streptococcus species, 12%; other gram-positive bacteria, 23%; gram-negative, 17%; fungal, 2.6%; and 11.5% of cultures returned no growth. 57 patients underwent surgery. Of these, 79% of the patients had undergone a trial of empiric antibiotics (cefepime and vancomycin) of the day prior to surgery. 44% underwent secondary surgeries, typically due to a heavy wound burden of necrotic tissue and pus. Postoperative antibiotics were prescribed to all patients. 51.6% of the patients were prescribed antibiotic therapy >6months. Overall mortality rate was 3.8%. Major cause of all deaths was septic shock. Post-infection sequelae occurred in 47.4% of patients. The most common sequelae were persistent or new sites of infection, sepsis, and abscess. Diabetes, hypertension, and renal failure appear to increase the risk of post-infection sequelae and death. While non-operative management was attempted in nearly 47%, ultimately 73% had surgery. This high rate may reflect our population of patients hospitalized in a tertiary care center. Available data suggests that patients presenting with hematogenous osteomyelitis be followed closely as failure of non-operative management, and resulting morbidity, was high.

MRI features of spinal chronic recurrent multifocal osteomyelitis/chronic non-bacterial osteomyelitis in children.

Spinal lesions in pediatric chronic recurrent multifocal osteomyelitis/chronic non-bacterial osteomyelitis (CRMO/CNO) can cause permanent sequelae; thus, early recognition of these is vital for management. To characterize the MR imaging features and patterns of pediatric spinal CRMO/CNO. This cross-section study received IRB approval. The first available MRI with documented spine involvement in children with CRMO/CNO was reviewed by a pediatric radiologist. Descriptive statistics were used to describe the characteristics of vertebral lesions, disc involvement, and soft tissue abnormality. Forty-two patients were included (F:M, 30:12); median age was 10years (range 4-17). At diagnosis, 34/42 (81%) had spine involvement. Kyphosis in 9/42 (21%) and scoliosis in 4/42 (9.5%) patients were present at the time of spinal disease recognition. Vertebral involvement was multifocal in 25/42 (59.5%). Disc involvement was found in 11/42 (26%) patients, commonly in the thoracic spine and often with adjacent vertebrae height loss. Posterior element abnormalities were present in 18/42 patients (43%) and soft tissue involvement in 7/42 (17%). One hundred nineteen vertebrae were affected, commonly the thoracic vertebrae (69/119; 58%). Vertebral body edema was focal in 77/119 (65%) and frequently superior (42/77; 54%). Sclerosis and endplate abnormality were present in 15/119 (13%) and 31/119 (26%) vertebrae, respectively. Height loss was present in 41/119 (34%). Chronic non-bacterial osteomyelitis of spine is usually thoracic. Vertebral body edema is often focal at the superior vertebral body. Kyphosis and scoliosis occur in a quarter and vertebral height loss in a third of children at spinal disease recognition.

Spondylodiscitis following ingestion of button battery in an infant-a case-based update.

Button battery ingestion in infants is an increasingly common surgical emergency which can lead to oesophageal perforation, mediastinitis, trachea-oesophageal fistulation, airway compromise and death. One exceedingly rare complication of battery ingestion is discitis and osteomyelitis in the cervical and upper thoracic spine. Diagnosis is normally delayed due to the non-specific presentation, delayed imaging findings and the initial clinical focus on dealing with the immediate, and potentially life-threatening, complications. We describe a case of a 1-year-old girl who presented with haematemesis and an oesophageal injury, secondary to button battery ingestion. Sagittal reconstruction of the CT chest demonstrated a suspicious area of vertebral erosion in the cervicothoracic spine which prompted a further evaluation with MRI demonstrating spondylodiscitis of C7-T2 with vertebral erosion and collapse. The child was successfully treated with long course of antibiotics. We wish to highlight the importance of clinical and radiological spinal assessment in children with button battery ingestion to avoid delayed diagnosis and complications of spinal osteomyelitis.

How Common Are Lesions on the Tails of Sauropods? Two New Pathologies in Titanosaurs from the Late Cretaceous of Argentine Patagonia

Studies of the paleopathology of the vertebrae provide an interesting, oblique approach to their paleobiology and even paleoethology. They tell us about possible ethological causes such as accidental blows with objects, social interactions within a group, and defense against predators, etc. There are numerous works on the anatomical and phylogenetic aspects of sauropod dinosaurs, and in recent years paleopathological studies have also increased. Here, we describe the injuries recorded in the caudal vertebrae of two indeterminate titanosaurids, and undertake a compilation and analysis of the pathological fossil record worldwide, focusing on the tails of sauropods. Two pathologies have been identified as present in the indeterminate titanosaurids under study: a possible case of spondyloarthropathy in MAU-Pv-LI-601, and a case of suppurative spinal osteomyelitis in MAU-Pv-LJ-472/1. Both titanosaurids are from Gondwana. In the world registry of pathologies associated with the tails of sauropod dinosaurs, it is observed that titanosaurs are the sauropods with the highest percentage of diagnosed pathologies (69% including the two new records from the province of Neuquén) and that all of these have been described in Gondwanan specimens.

Beta-lactam-resistant Staphylococcus aureus in spinal osteomyelitis and spondylodiscitis: current landscape in antibiotic resistance, treatment, and complications.

Spinal osteomyelitis and spondylodiscitis (SD) are infections of the vertebral body and disc, respectively, with more than 50% associated with Staphylococcus aureus. Methicillin-resistant S. aureus (MRSA) has become a pathogen of interest in cases of SD due to increasing prevalence. The purpose of this investigation was to characterize the current epidemiological and microbiological landscape in SD cases, in addition to medical and surgical challenges in treating these infections. The PearlDiver Mariner database was queried for ICD-10 codes to identify cases of SD from 2015 to 2021. The initial cohort was stratified by offending pathogens, including methicillin-sensitive S. aureus (MSSA) and MRSA. Primary outcome measures included epidemiological trends, demographics, and rates of surgical management. Secondary outcomes included length of hospital stay, rate of reoperation, and complications associated with surgical cases. Multivariable logistic regression was used to control for age, gender, region, and Charlson Comorbidity Index (CCI). Nine thousand nine hundred eighty-three patients met the inclusion criteria and were retained for this study. Approximately half (45.5%) of SD cases resulting from S. aureus infections each year were resistant to beta-lactam antibiotics. The proportion of cases that were managed surgically was 31.02%. Among the cases that involved surgical intervention, 21.83% underwent revision operations within 30 days of the original procedure and 37.29% of cases returned to the operating room within 1 year. Substance abuse, specifically alcohol, tobacco, and drug use, were strong predictors for surgical intervention in cases of SD (all p < 0.001), in addition to obesity (p = 0.002), liver disease (p < 0.001), and valvular disease (p = 0.025). After adjusting for age, gender, region, and CCI, cases of MRSA were more likely to undergo surgical management (OR 1.19, p = 0.003). MRSA SD also exhibited higher rates of reoperation within 6 months (OR 1.29, p = 0.001) and 1 year (OR 1.36, p < 0.001). Surgical cases resulting from MRSA infections also exhibited higher morbidity and significant rates of transfusion (OR 1.47, p = 0.030), acute kidney injury (OR 1.35, p = 0.001), pulmonary embolism (OR 1.44, p = 0.030), pneumonia (OR 1.49, p = 0.002), and urinary tract infection (OR 1.45, p = 0.002) compared with MSSA SD infections. More than 45% of cases of S. aureus SD in the US are resistant to beta-lactam antibiotics, presenting obstacles in treatment. Cases of MRSA SD are more likely to be managed surgically and have higher rates of complications and reoperations. Early detection and prompt operative management are imperative to reduce the risk of complications.

Air-fluid level in the mediastinum.

A 19-year-old man presented to the emergency department with weakness, loss of appetite, and a weight loss of at least 13 kg in 5 months. He also complained of exertional dyspnea, dry cough, day and night sweats, and abdominal plus lower back pain. The physical examination revealed a temperature of 39.3°C but nothing else abnormal. The chest x-ray (Figure 1) revealed a mass that appeared to be located in the posterior mediastinum. A computed tomography (CT) scan (Figure 2) was performed in the emergency department to assess the extent of the disease, which showed pulmonary tuberculosis and spinal osteomyelitis associated with a perispinal collection from T1 to T12 and from L5 to S2, suggesting Pott's disease.1 The diagnosis of disseminated tuberculosis was confirmed by the presence of Mycobacterium tuberculosis in culture.2 A quadri-therapy for tuberculosis was initiated with isoniazid, rifampicin, pyrazinamide, and ethambutol, then downgraded to a tri-therapy because of the absence of resistance at the antibiogram.3 Magnetic resonance imaging (Figure 3) performed later during the hospitalization revealed a staged spondylodiscitis associated with collections from the beginning of the extension to the central nervous system. Echocardiography confirmed the presence of associated chronic pericarditis. Finally, the indication for radio-controlled drainage of the posterior mediastinal collection was decided owing to the important risk of fistulization.4 Tuberculosis is caused by slow growing aerobic bacilli, Mycobacterium tuberculosis complex. This disease, affecting mainly the lungs, also takes osteoarticular forms, the most frequent of which is spondylodiscitis. Spinal involvement is always secondary to hematogenous dissemination of bacilli from the primary site.5 Pott's disease results from an infection of the vertebrae (spondylitis) and intervertebral discs (discitis) with M. tuberculosis. The intervertebral disc is a relatively avascular structure and is spared until late stage of the disease. Bone destruction in spinal tuberculosis can be fragmentary, osteolytic, subperiosteal, or localized destruction with sclerosed margins. Cold abscesses are pus collections that lack surrounding inflammatory response and are seen in nearly 70% of patients with spinal tuberculosis. This is a severe form of the disease, located near nerve structures, which may be significantly and permanently affected, and may be life threatening.

Therapeutic Taping to Offload Wound Margin Strain and as an Adjunct to Wound Closure: A Case Report

Introduction. Wound complications are common, difficult to manage, and carry a high economic burden. They are challenging to physicians and a burden to society. Case Report. An 86-year-old male with a history of diabetes was diagnosed with spinal suppurative osteomyelitis and underwent spinal debridement and debridement of dead bone, which required an incision of approximately 9 cm in length. Poor wound healing was noted on postoperative day 5, and wound healing had not been achieved by postoperative day 82. The periphery of the wound was stretched using a proprietary elastic therapeutic tape beginning on postoperative day 82, and daily routine disinfection was maintained thereafter. Wound healing was achieved after 2 months of the aforementioned routine. No additional wound changes were noted at the 6-month follow-up after wound healing was confirmed. Conclusions. Use of elastic therapeutic taping aided in healing a chronic nonhealing wound after spinal surgery in 1 case. The mechanism of action is discussed and analyzed to provide clinical evidence for such treatment.

Identification of Cutibacterium modestum in Spondylitis by Metagenomics Analysis.

Identifying pathogens with culture-negative pyogenic spondylitis is difficult. Shotgun metagenomic sequencing is an unbiased and culture-free approach in the diagnosis of infectious diseases. There are, however, a variety of contaminating factors that can confound the precision of metagenomic sequencing. In a 65-year-old man suffering from culture-negative L3-5 spondylitis, metagenomics was applied to facilitate the diagnosis. The patient underwent percutaneous endoscopic lumbar discectomy. We applied metagenomic sequencing with a robust contamination-free protocol to the bone biopsy. By comparing the abundance for each taxon between the replicates and negative controls, we reliably identified Cutibacterium modestum as having a statistically higher abundance in all replicates. The patient's antibiotic therapy was switched to penicillin and doxycycline based upon the resistome analysis; the patient fully recovered. This application of next-generation sequencing provides a new perspective in the clinical approach to spinal osteomyelitis and illustrates the potential of this technique in rapid etiological diagnosis.

ПРОБЛЕМА САХАРНОГО ДИАБЕТА В ЛЕЧЕНИИ ВЕРТЕБРАЛЬНОЙ ИНФЕКЦИИ

The study included 88 patients with vertebral infection (nonspecific spinal osteomyelitis – M46.3, spinal epidural abscess – G06.1), of which 24 (27.3%) had diabetes. If the patient had impaired glucose metabolism, the lethality increased by 3.9 times. A key factor in the development of severe neurological deficit in patients with vertebral infection was the combination of epiduritis and diabetes. With the help of cluster analysis, it was found that the highest mortality (45%) is observed in patients who, in addition to the inflammatory focus in the spine, had diabetes, coronary heart disease and nephropathy.

Finding MRI features to obviate the need of repeat spinal biopsies in clinically suspected persistent or recurrent spinal osteomyelitis.

The aim of this study was to determine magnetic resonance imaging (MRI) features that could help differen-tiate the bone destruction due to persistent/recurrent spine infection from worsening bone destruction due to mechanical factors, which could help obviate the need for repeat spine biopsy. A retrospective study was performed on selected subjects who were more than 18 years of age, were diagnosed with infectious spondylodiscitis, underwent at least 2 spinal interventions for the diagnosis at the same level, and had MRI prior to each image-guided intervention. Both MRI studies were analysed for vertebral body changes, paravertebral collections, epidural thickening and collections, bone marrow signal changes, loss of vertebral body height, abnormal signal in intervertebral disc, and loss of disc height. We observed that worsening of changes in paravertebral and epidural soft tissue were statistically more significant predictors of recurrent/persistent spine infection (p< 0.05). However, worsening destruction of vertebral body and intervertebral disc, abnormal vertebral marrow signal changes, and abnormal signal in intervertebral disc did not necessarily indicate worsening infection or recurrence. In patients of infectious spondylitis with suspected recurrence, the most common and pronounced MRI findings of worsening osseous changes can be deceiving and can result in negative repeat spinal biopsy. Changes in paraspinal and epidural soft tissues are more helpful in identifying the cause of worsening bone destruction. Correlation with clinical examination, inflammatory markers, and observing soft tissue changes on follow-up MRI is a more reliable way to identify patients who may benefit from repeat spine biopsy.

Primary spinal infections: A retrospective review of instrumentation use and graft selection.

The use of instrumentation in the setting of primary spinal infections is controversial. While the instrumentation is often required in the presence of progressive deformity due to spinal osteomyelitis (SO), discitis (SD), or spinal epidural abscesses (SEA), many surgeons are concerned about instrumentation increasing the risk of infection recurrence and/or persistence warranting reoperation. We retrospectively reviewed the need for reoperations for persistent infections in 119 patients who presented with primary spinal infections. They were treated with decompressions with/without non-instrumented fusion (70 patients) versus decompressions with instrumented fusions (49 patients). The use of primary spinal instrumentation in the presence of infection (SO/SD/SEA) did not increase the requirement for repeated surgery due to recurrent/residual infection when compared to those undergoing decompressions with/without non-instrumented fusions. Of 49 patients who initially required instrumentation, 6 (12.5%) required reoperations for recurrent or residual infection. For the 71 undergoing index decompressions for infection with/without non-instrumented fusion, 9 (12.7%), or nearly an identical percentage, required reoperations for recurrent/residual infection (P = 0.93). The use of instrumentation in the treatment of primary spinal infections in a small sample of just 49 patients did not increase the risk for persistent infection warranting reoperations versus 70 patients undergoing initial decompressions with/without non-instrumented fusions.

Assessing the Effects of Prior History of Vertebral Osteomyelitis on Peri-Operative Factors and Post-Operative Recovery in Adult Spinal Deformity Patients.

Vertebral osteomyelitis (VOM), which includes the clinical entities of spinal osteomyelitis, spondylodiscitis, or pyogenic spondylitis, describes a complex inflammatory reaction within the vertebral column in the setting of microbial infection [...].

196. Clinical characteristics of 98 patients presenting with hematogenous spinal osteomyelitis: An observational study

<h3>BACKGROUND CONTEXT</h3> Most spinal infection occurs in the wake of invasive procedures, wherein flora have been directly inoculated into the spine and its surrounding soft tissues. Hematogenous infections, on the other hand, result from bacterial spread from a distant site. Staphylococcus aureus is the most common cause of hematogenous spinal infections, and most cases resolve with a 6-week course of antibiotics. However, some patients, especially those that present with concurrent epidural abscess and neurological embarrassment, require debridement of the site and potential structural stabilization. Since very few studies report the clinical characteristics of patients requiring surgery or succumbing to this disease state, this study aims to detail our series of patients with hematogenous spinal osteomyelitis. <h3>PURPOSE</h3> To report clinical characteristics of patients with hematogenous spinal osteomyelitis <h3>STUDY DESIGN/SETTING</h3> Retrospective study. <h3>PATIENT SAMPLE</h3> A total of 98 patients with hematogenous vertebral osteomyelitis. <h3>OUTCOME MEASURES</h3> Preoperative (preop) and postoperative (postop) courses of antibiotics, surgery, reoperation, length of hospital stay, postop sequelae and death. <h3>METHODS</h3> The medical records of patients presenting to two tertiary care centers from January 2014 to January 2021 with hematogenous spinal osteomyelitis were abstracted using ICD-10 codes M46.20 to M46.59. We collected age, sex, body mass index (BMI), comorbidities, affected spinal region, microbiological details, type and duration of pre- and postop antibiotics, length of hospital stay (LOS), reoperation and mortality. Long-term antibiotics were those in use > 6 months. <h3>RESULTS</h3> A total of 98 consecutive patients presenting with hematogenous vertebral osteomyelitis were included. Demographically, the mean age was 62±10 years; 61.2% (n-=60) were male; mean BMI was 29.2±10.4. Most of the infections occurred in the lumbar region (44.2%), followed by the thoracic spine (37.9%), more than two spinal regions (9.5%) and cervical spine (8.4%). Biopsy was performed in 94.1% and returned positive cultures in 93.4%. Of the cultures taken, gram positive bacteria accounted for 69.2%, gram negative in 16.7%, and fungus in 2.6%. 11.5% of cultures returned no growth. 76 (77.6%) patients underwent surgery while 22 (22.4%) were treated with antibiotics only. Of the 76 undergoing surgery, 34.2% underwent secondary surgeries due to a heavy wound burden of necrotic tissue and pus or the failure of multimodal care including antibiotics and debridement. 51.6% of the patients had been prescribed antibiotics preoperatively, with a mean course of 37.2±25.7 days. Postoperative antibiotics were prescribed to all patients, with a mean length of 70.2 days. Mean LOS was 17.9±15.3 days. Additionally, 51.6% of the patients were prescribed long-term antibiotic therapy. The overall death rate was 3.1% (n=3). All 3 patients underwent surgery. Demographic and clinical characteristics of the deceased patients include a mean age of 64 years, majority male (66.7%), who had major comorbidities such as diabetes, anemia, obstructive lung disease and hypertension. Major cause of death was septic shock. Major post-infection sequelae occurred in 24.5% (n=24) of patients. Patients suffering sequelae had a mean age of 69.3 years, were mostly male (83%) and carried major comorbidities including diabetes, anemia, hypertension and renal disease. The most common sequelae were major motor weakness, wound dehiscence and meningitis. <h3>CONCLUSIONS</h3> This study describes the clinical characteristics of patients presenting with hematogenous spinal osteomyelitis, their treatment course and outcomes. As in other sites of infection, the presence of major comorbidities (diabetes, hypertension and renal failure) appear to increase the risk of developing post infection sequalae and death. Our population included patients hospitalized in a tertiary care center with spinal osteomyelitis. They were therefore more likely to carry concomitant diagnoses such as epidural abscess, resulting in a high rate of surgical intervention. A future study with a larger sample size utilizing logistic regression would be able to identify significant risk factors both for hematogenous infection itself and for failure of non-operative and initial operative care. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Cervical Spine Osteomyelitis After Direct Rigid Laryngoscopy and Balloon Dilation

Cervical Spine Osteomyelitis After Direct Rigid Laryngoscopy and Balloon Dilation