Spine Case 11 Diagnosis

Vertebral osteomyelitis and discitis

The diagnosis of VO is suspected clinically by back pain and possibly fever in immunocompromised patients. This suspicion is heightened by abnormal laboratory results, such as elevated ESR/CRP, white blood cell count, and positive blood cultures. The diagnosis is confirmed with imaging studies. X rays can show erosive disease of sequential vertebrae but are negative early in disease. MRI is the most sensitive test for VO and should be ordered when the diagnosis is being considered. MRI findings include loss of signal intensity of the vertebral bodies or discs and end plate destruction.