Hematogenous spondylitis. Would you have known that?

Vertebral osteomyelitis is the main manifestation of hematogenous osteomyelitis in patients aged over 50 years. Because of an increasing multimorbidity of the primarily elderly patient population the incidence is increasing. Diagnosis is often delayed due to the rarity of the disease, the uncharacteristic symptoms and the high frequency of low back pain in the general population. Staphylococcus aureus followed by Escherichia coli (E. coli) are the most commonly isolated pathogens and the lumbar spine the most commonly affected area. Magnetic resonance imaging is the preferred radiologic modality because of its sensitivity. Computer tomography guided bone biopsy or blood cultures are crucial in the evaluation of the infection. Antimicrobial therapy of at least 6 weeks duration is recommended and should be tailored to the pathogens recovered from the culture. Acute vertebral osteomyelitis can usually be treated with antibiotics alone. Surgery is indicated in cases of persistent instability related pain, neurologic symptoms and abscess formation.