Vertebral Osteomyelitis in Paraplegia: Incidence, Risk Factors, Clinical Picture

PURPOSE: Because vertebral osteomyelitis (VOM) appears to be relatively common among patients paralyzed due to myelopathy, a population of these patients was surveyed to A) estimate the incidence of VOM, B) identify risk factors, and C) review clinical features. METHOD: The cohort of 537 patients with myelopathy paralyzed prior to January 1, 1989 and subsequently hospitalized at the authors' facility over an 11-year survey period was surveyed. All were male, 93% had a traumatic etiology of paralysis, 50% were > or = 50 years of age, 53% were paraplegic, 54% were motor and sensory complete, and 56% had been paralyzed for 15 years or more. VOM was diagnosed by computerized tomographic demonstration of intervertebral end plate destruction and a positive culture of that site. The relative incidences of VOM were calculated as cases per spinal cord injury (SCI) and general hospitalizations; potential risk factors were assessed by rates of VOM in the myelopathy cohort and clinical features of VOM in these patients were noted. RESULTS: Ten patients with myelopathy developed VOM, an incidence of 20.9 cases/10,000 SCI versus 1.8 cases/10,000 general hospitalizations. The risk ratio was 7.1 (p = .05) for paraplegia, 7.9 (p = .04) for motor and sensory completeness, and 4.4 (p = .06) for diabetes mellitus. The risk ratio for the 3 factors combined was 14.5 (p = .001). Initial clinical presentations were notable for back pain and plain radiographic films revealing paraspinal masses and pleural effusion. CONCLUSIONS: Patients with myelopathy are uniquely at risk for VOM if their paralysis is at the paraplegic level and is motor and sensory complete.