Spinal Osteomyelitis Associated with Urinary Tract Infections

This communication is concerned primarily with the relationship between urinary tract infection and osteomyelitis of the spine. This association has been realized for a number of years and sporadically described, mostly in the form of case reports. In 1940, Batson (2) published a classic anatomic study in which he proved the presence of numerous intercommunications between the veins of the pelvic organs and those of the vertebral column. He postulated that, by means of these channels, tumors and abscesses of the pelvic organs may spread directly to the spine, by-passing the caval system. Since the publication of Batson's paper, an increasing number of articles have appeared (1, 3, 4–13). We are presenting here 9 cases in which spinal osteomyelitis followed one or more bouts of urinary tract infection. Case Reports Case I J.W.C., white male, age 74. In October 1950, this patient had a transurethral resection for benign prostatic hypertrophy. During 1951, he was seen repeatedly because of urinary infections and retention. Urine cultures grew Proteus. Following drainage of a periurethral abscess and a suprapubic cystotomy on Aug. 27, 1951, severe pain developed in the lower back and hips, persisting over a period of weeks. Roentgenograms of the lumbar spine on Oct. 1, 1951, revealed an osteomyelitis at the L5-S1 level (Fig. 1). Antibiotic therapy was instituted. Subsequent film studies showed further destruction. In May 1952, heart failure developed and the patient died at home. An autopsy was not performed. Case II G.L.M., white male, age 63. In November 1949, a roentgenogram disclosed a left renal calculus. Early the next month the patient was admitted to the hospital. Following a cystoscopic examination, a severe prostatitis and cystitis developed but responded to penicillin. On Dec. 7, 1949, a transurethral resection was done. During convalescence, mild low back pain occurred, different from the earlier flank pain; this continued through the hospital stay. On Jan. 10, 1950, the renal calculus was removed. During convalescence from this operation, the patient began to experience back pain at a higher level in the dorsal region, radiating forward around the chest wall. On March 12, 1950, because of the persistent back pain, he was readmitted to the hospital. Roentgenograms at this time revealed inflammatory lesions in the spine at the L1–2 and D7-8 levels (Fig. 2, a and b). A needle aspiration of the lumbar lesion was done (Fig. 2, c and d), and culture of the aspirated material grew Pseudomonas. A second aspiration was unsuccessful in obtaining material. The osteomyelitis was treated vigorously with antibiotics and healed slowly. Case III E.A.C., white male, age 53, was admitted to the hospital on April 13, 1954, with a four-month history of progressive interscapular pain, constant in nature and greatly exaggerated by movement.