Osteomyelitis in spinal cord injured people.

Prospective evaluation of 285 spinal cord injured patients at the Houston VAMC over a consecutive 44-month period identified 60 cases of osteomyelitis: 41 cases of infected bone beneath pressure sores, 8 bone infections around the site of insertion of metal fixation devices, 5 cases of vertebral osteomyelitis, and 6 other causes and types of bone infection. As reported before, significant problems with the lack of specificity of roentgenograms, bone scans, and gallium scans were encountered; over half the patients without osteomyelitis on bone biopsy (with multiple biopsy specimens) had abnormalities in at least one of these studies suggestive of osteomyelitis. Bone biopsy was usually necessary to confirm the diagnosis of bone infection and isolate the causative micro-organisms. More patients than previously reported seem to have been cured with topical care and appropriate systemic antimicrobial therapy. If preventive care fails, early diagnosis and antimicrobial therapy seem to improve the cure rate and prevent chronicity of osteomyelitis in this patient group.