Anatomic basis for the pathogenesis and radiologic features of vertebral osteomyelitis and its differentiation from childhood discitis. A microarteriographic investigation.

Microarteriography has demonstrated the anatomy which explains the pathogenesis and radiologic features of adult vertebral osteomyelitis and of childhood discitis. Infarction is caused in the metaphysis by a septic embolus. The intraosseous arteries in children are anastomotic and a small portion of bone is destroyed. In adults a larger portion of bone is destroyed because the intraosseous arteries are end-arteries and septic thrombosis spreads into peripheral intraosseous arteries. The disc is avascular at all ages and is attacked by infection equally. The trans-equatorial spread of osteomyelitis occurs via an artery which is first described here. It joins the metaphyseal anastomoses of the same vertebral body in the midline.