Pyogenic vertebral osteomyelitis presenting as single spinal compression fracture: a case report and review of the literature.

STUDY

DESIGN

A case report of pyogenic vertebral osteomyelitis (PVO) presenting as single collapsed vertebral body without narrowing of the intervertebral disc space, and review of the literature.

OBJECTIVE

To describe an unusual case of PVO showing atypical radiological change and call attention to this condition so that others may avoid this diagnostic pitfall.

SETTING

Japan.

METHODS

A 62-year-old diabetic woman with suspected T12 pathological fracture of malignant spinal tumor and neurological involvement received urgent anterior decompression and spinal reconstruction without biopsy.

RESULTS

Anterior decompression and spinal reconstruction was performed, but histological examination of the specimen after surgery unexpectedly revealed PVO. The surgery was followed by therapy with antibiotics for 7 months. A follow-up radiograph at 5 years after surgery revealed that solid consolidation has been achieved.

CONCLUSIONS

Diagnosis of PVO presenting with single spinal compression fracture is very difficult. Although the finding of the high signal intensity in the lesion equal to or higher than that of the cerebrospinal fluid on T2-weighted MR image seemed to be the most reliable diagnostic modality retrospectively, diagnosis of this type of PVO is impossible without histology. A needle biopsy before surgery is strongly recommended.