Pyogenic vertebral osteomyelitis/disc infection.

Spinal osteomyelitis has been known about for centuries. Granulomatous infection was the principal offender in the past, but nowadays, with an increased number of patients at 'risk', the proportion of pyogenic infections has risen. Awareness of this is the essence of early diagnosis. The advent of magnetic resonance imaging has proved a major milestone; with its high sensitivity and specificity, it is an essential part of the diagnostic work-up. The treatment of spinal osteomyelitis follows the same basic principles as for any infection. Once the diagnosis has been established, early conservative treatment is commenced. Debridement, drainage of any abscesses, spinal decompression and stabilization are options in surgical treatment. The successful use of metallic implants to achieve correction and stabilization is probably helped by good perfusion of the vertebral body and accompanying good soft tissue coverage. The eradication of infection is therefore still possible. Copyright 1999 Harcourt Publishers Ltd.