Background/Purpose: In a previous work, we showed that neurological complication can occur in up to 40% of patients with vertebral osteomyelitis (VO). Bed rest and spine immobilization are usually prescribed to prevent those complications. There is currently no consensus about the best immobilization protocol to follow in VO. Objectives of our work were to assess the prescription of spine immobilization for VO and its effect of neurological complications.

Methods: A prospective study was performed in 10 centers. All patients with native VO were included and followed prospectively: neurological complications, imaging findings, type and duration of immobilization were reported and patients were divided in two groups: “Immobilization” or “No Immobilization”, regarding if they had a prescription of spine bracing or not. We present here the data of our study after 6 months of follow-up.

Results:

To date, 102 patients were included: 72 in the “Immobilization” group, and 30 in the “No Immobilization” group. Median duration of symptoms before diagnosis was 27 days, IQR (11-40).

Thirty-six percent of the patients (n=37) had an abnormal neurological exam at baseline: 23.5% (n=24) had minor neurological signs (sensory loss or radiculopathy), and 12.7% (n=13) had major neurological signs (motor deficit or cauda equine syndrome). During hospital stay, 4 patients developed major neurological signs (median 5 days after diagnosis) and 5 patients developed minor neurological signs (median 6 days after diagnosis). Half of the patients with abnormal neurological exam at baseline had a normal neurological examination at 6 months.

Median duration of bed rest was 9 days (IQR 7-18). In the “Immobilization” group (n=72), median duration of spine bracing was 8 weeks, IQR (6-12) and it was rigid bracing in 90% of cases. Main characteristics of the 2 groups are described in Table 1. They were no significant differences in age, associated diseases, or pathogen. Only one patient in the “No Immobilization” Group developed a paraplegia during follow-up, and the reason of the absence of immobilization was unclear. All patients with cervical involvement had a prescription of spine immobilization, whereas only half of the patients with lumbar involvement were immobilized. There were significantly less thoracic spine involvement in the “Immobilization” group. There were no differences in terms of neurological complications during follow-up between the two groups.

Conclusion:

Neurological complications occurred in 36% of our patients. Interestingly, 30% of our patients were not immobilized. None of them had cervical involvement and neurological outcome was favorable for 95% of “Not Immobilized” patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/spine-immobilization-and-neurological-complications-in-vertebral-osteomyelitis-results-from-a-multicenter-prospective-observational-study/