Vertebral Osteomyelitis

In a series of 24 patients with proved hematogenous, pyogenic vertebral osteomyelitis, the disease was insidious in onset in 20. Because x-ray findings were inconclusive, vertebral-body biopsy was required for an accurate diagnosis, when the blood culture was negative. Despite the frequent presence of abnormal roentgenographic shadows, drainage was required in only two patients. Exploration for abscess cannot be determined on the basis of roentgenographic findings alone. The frequency of a benign course and failure of spontaneous arthrodesis induced speculation concerning possible attenuation of the virulence of the organism, altered host immunity, or perhaps, with regard to spontaneous fusion, merely a modification of an end point of the pathologic process by antibiotic treatment.