title: Risk factors and prognosis of vertebral compressive fracture in pyogenic vertebral osteomyelitis.
abstract: OBJECTIVE
  To analyse the clinical, microbiological and radiological characteristics, and to identify risk factors of vertebral compressive fracture (VF) in spontaneous pyogenic vertebral osteomyelitis (VO).
  
  
  METHODS
  A retrospective clinical study and blinded radiological review of adult patients with VO.
  
  
  RESULTS
  Eighty-eight patients were included: 57 (65%) had a definitive diagnosis of VO (positive microbiology), and 31 (35%) had a probable diagnosis of VO. Of these, 27 (30.7%) presented with VF at diagnosis of VO, and 4 afterwards (total 31, 35.2%). Patients with VF were considered to be at higher risk of osteopenia--they were older (74 vs 66 years, p = 0.013), and included high percentage of women (33 vs 41%, NS)--; and presented more dorsal involvement (56 vs 21%; p < 0.007). Causal microorganisms were similar between groups (VF, no VF). The time to diagnosis of VO was longer in the presence of VF (65 vs 23 days, p = 0.001), and also in cases with no isolated organisms. All patients received antibiotics, and just one patient required spinal stabilisation (VF). After 357 median days of follow-up, all patients were cured. Clinical improvement (residual pain, functional recovery) tended to be slower in patients with VF (log-rank 0.19 and 0.15, respectively), but clinical symptoms were similar in most patients at the last follow-up (VF, no VF).
  
  
  CONCLUSIONS
  VF is a common complication in pyogenic VO that causes slower clinical recovery. Risk factors of VF are: osteopenia, a delayed diagnosis and dorsal involvement. Conservative management is probably appropriate for most cases, but spinal stabilisation should be considered in some specific cases.
authors.affiliation: Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet de LLobregat, Barcelona, Spain. albaribera@gmail.com.
authors.forename: Alba
authors.initials: A
authors.lastname: Ribera
authors.affiliation: Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet de LLobregat, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Labori
authors.affiliation: Radiology Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Hernández
authors.affiliation: Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet de LLobregat, Barcelona, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Lora-Tamayo
authors.affiliation: Orthopaedic Surgery Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain.
authors.forename: Lluís
authors.initials: L
authors.lastname: González-Cañas
authors.affiliation: Orthopaedic Surgery Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain.
authors.forename: Federic
authors.initials: F
authors.lastname: Font
authors.affiliation: Rheumatology Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Nolla
authors.affiliation: Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet de LLobregat, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Ariza
authors.affiliation: Radiology Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Narváez
authors.affiliation: Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet de LLobregat, Barcelona, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Murillo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000150:complications* / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016103:Spinal Fractures / Q000453:epidemiology* / Q000473:pathology*
keywords: Pyogenic vertebral osteomyelitis; Spodylodiscitis; Vertebral collapse; Vertebral compressive fracture