Background/Purpose:

Vertebral osteomyelitis is a rare but potentially severe disease: previous works have estimated that neurological complications occurred in up to 59% cases. However, these works were mainly surgical studies, so neurological complications might have been overestimated.

The aim of our study was to evaluate the frequency of neurological deficit (motor deficit: ASIA grade A to D and/or sphincter dysfunction) in a non-selected population of patients with pyogenic vertebral osteomyelitis and to find clinical and MRI signs associated with these complications.

Methods:

We reviewed medical charts of all patients with spondylodiscitis from 2007 to 2014 in a University Hospital and we included patients aged 18 years or older with infectious spondylodiscitis confirmed by MRI and with an identification of the causative agent or a good response to antibiotic therapy if all microbiological samples were sterile.

Results:

One hundred and twenty one patients were included. Mean age was 64.3 +/-15.6 years, mostly men (68.6%, n=83). Median duration of clinical signs before diagnosis on MRI was 21.5 days. Lombo-sacral spine was the most frequently affected (38%, n=46), followed by thoracic (23.1%, n=28), and cervical spine (19%, n=23). The 24 remaining patients (19.8%) had multifocal lesions. Overall, we found that 21.5% (n=26) of the patients had a neurological compromise and 14% (n=17) had surgical therapy for spinal or root nerve decompression. Neurological deficit was present at the time of admission for 14 patients and occurred during antibiotic course for 12 patients, on average 13 days after diagnosis (1-39 days). On MRI, 75.2% of patients (n=91) had an epidural inflammation 39.7% (n=48) had an epidural abscess. Clinical findings associated with motor deficit were: bacteriemiae (OR 3.36, p=0.04), acute onset of symptoms (<7 days) (OR 8.73, p=0.004). We found that several MRI patterns were associated with the presence of a neurological deficit: Cervical spine lesions (OR 3.36, p=0.011), dural compression (OR 5.22, p=0.0012), cerebro-spinal fluid interruption (OR 5.59 p<0,001), signal changes of the spinal cord (OR 6.82, p=0,006). Destruction of more than 50% of the sus-jacent vertebrae volume, kyphosis and erosions of the posterior column were also associated with higher risk of motor deficit: OR 8.45, p=0.017, OR 4.01, p=0.016 and OR 5.58, p=0.032, respectively. Finally, neither epidural phlegmon nor epidural abscesses, multifocal lesions, loss of disk height, nor roots nerve compression were associated with a higher risk of neurological deficit.

Conclusion:

Severe neurological deficit occurred in 1/5 of our patients. Patients with a cervical involvement, major vertebrae destruction and static troubles such as kyphosis, dural compression, cerebro-spinal fluid interruption and signal changes of the spinal cord on MRI were at risk of neurological deficit. In contrast, epidural abscesses or nerve roots compression were not significantly associated with such complications.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mri-changes-associated-with-neurological-compromise-in-acute-pyogenic-vertebral-osteomyelitis-a-retrospective-study-of-121-patients/