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The Correlation of the Initial Clinical, Laboratory and MRI Findings with the Disease Outcome in Patients with Vertebral Osteomyelitis

PURPOSE: To analyze the initial clinical, laboratory and magnetic resonance imaging (MRI) findings in patients with vertebral osteomyelitis and to determine their correlation with the disease outcome. METHODS AND MATERIALS: A retrospective study of 110 patients with confirmed pygenic vertebral osteomyelitis, treated in 5-year period. Patients included in the study initially had clinical and biological examinations and MRI of spine according to the same protocol. MRI findings were divided in moderate and advanced changes. Complete clinical recovery, residual neurological deficits or pain and death were observed as the disease outcome and put in correlation with clinical and imaging findings. RESULTS: There was no significant difference in clinical presentation at admission, number of affected vertebral bodies nor anatomic location between a group of patients with moderate and patients with advanced MRI changes. High Charlson comorbity index (CCI) score and longer treatment with antibiotics were associated with advanced MRI changes (p=0.006 and p=0.004, respectively). Patients with advanced MRI changes more frequently underwent surgical intervention than patients with moderate MRI changes of vertebral osteomyelitis (p=0.007). There was no difference between patients with moderate and patients with advanced MRI changes regarding the disease outcome (p=0.563). CONCLUSION: Although the patients with advanced MRI changes are more likely to need prolonged antibiotic therapy and surgical intervention, the findings of initially performed MRI in patients with pyogenic vertebral osteomyelitis have no prognostic value regarding the disease outcome. The advanced MRI changes in patients with vertebral osteomyelitis are more often observed in patients with high CCI score, probably due to impaired immune response caused by diabetes or chronic renal failure or because of partial modulation of the immune response with medications in patients with inflammatory rheumatic diseases.

MRI; vertebral osteomyelitis; disease outcome

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