Osteomyelitis of the spine: treatments and future directions

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Abstract

Background:

Osteomyelitis of the spine is a serious condition that has been increasing with the intravenous drug pandemic and aging population. Multiple different organisms can cause osteomyelitis and mainstay of treatment is early recognition and antibiotics. The course can sometimes be indolent leading to delayed presentations. Once suspected, comprehensive workup and initiation of management should be employed. In rare circumstances, surgical evacuation or deformity correction is indicated. Continued antibiotic treatment should be considered post-operatively.

Methods:

Emerging treatment solutions are being developed to help target osteomyelitis in a more effective manner. In this review, we highlight the epidemiology and pathophysiology of spinal osteomyelitis. We overview the diagnostic workup and treatment options. Finally, we present new options that are currently being investigated and are on the near horizon.

Conclusion:

This review offers a user friendly resource for clinicians and researchers regarding osteomyelitis of the spine and will serve as a catalyst for further discovery.

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Most cited references 66

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Phage therapy in clinical practice: treatment of human infections.

Zemphira Alavidze, Hjalmar S Kühl, Guram Gvasalia … (2009)

Phage therapy is the application of bacteria-specific viruses with the goal of reducing or eliminating pathogenic or nuisance bacteria. While phage therapy has become a broadly relevant technology, including veterinary, agricultural, and food microbiology applications, it is for the treatment or prevention of human infections that phage therapy first caught the world's imagination--see, especially, Arrowsmith by Sinclair Lewis (1925)--and which today is the primary motivator of the field. Nonetheless, though the first human phage therapy took place in the 1920s, by the 1940s the field, was in steep decline despite early promise. The causes were at least three-fold: insufficient understanding among researchers of basic phage biology; over exuberance, which led, along with ignorance, to carelessness; and the advent of antibiotics, an easier to handle as well as highly powerful category of antibacterials. The decline in phage therapy was neither uniform nor complete, especially in the former Soviet Republic of Georgia, where phage therapy traditions and practice continue to this day. In this review we strive toward three goals: 1. To provide an overview of the potential of phage therapy as a means of treating or preventing human diseases; 2. To explore the phage therapy state of the art as currently practiced by physicians in various pockets of phage therapy activity around the world, including in terms of potential commercialization; and 3. To avert a recapitulation of phage therapy's early decline by outlining good practices in phage therapy practice, experimentation, and, ultimately, commercialization.

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Immunological mechanisms contributing to the double burden of diabetes and intracellular bacterial infections.

Kelly Hodgson, Jodie Morris, Tahnee Bridson … (2015)

Diabetes has been recognized as an important risk factor for a variety of intracellular bacterial infections, but research into the dysregulated immune mechanisms contributing to the impaired host-pathogen interactions is in its infancy. Diabetes is characterized by a chronic state of low-grade inflammation due to activation of pro-inflammatory mediators and increased formation of advanced glycation end products. Increased oxidative stress also exacerbates the chronic inflammatory processes observed in diabetes. The reduced phagocytic and antibacterial activity of neutrophils and macrophages provides an intracellular niche for the pathogen to replicate. Phagocytic and antibacterial dysfunction may be mediated directly through altered glucose metabolism and oxidative stress. Furthermore, impaired activation of natural killer cells contributes to decreased levels of interferon-γ, required for promoting macrophage antibacterial mechanisms. Together with impaired dendritic cell function, this impedes timely activation of adaptive immune responses. Increased intracellular oxidation of antigen-presenting cells in individuals with diabetes alters the cytokine profile generated and the subsequent balance of T-cell immunity. The establishment of acute intracellular bacterial infections in the diabetic host is associated with impaired T-cell-mediated immune responses. Concomitant to the greater intracellular bacterial burden and potential cumulative effect of chronic inflammatory processes, late hyper-inflammatory cytokine responses are often observed in individuals with diabetes, contributing to systemic pathology. The convergence of intracellular bacterial infections and diabetes poses new challenges for immunologists, providing the impetus for multidisciplinary research. © 2014 John Wiley & Sons Ltd.

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2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults.

Elie F Berbari, Souha Kanj, Todd Kowalski … (2015)

These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neurosurgeons, radiologists, and other healthcare professionals who care for patients with native vertebral osteomyelitis (NVO). They include evidence and opinion-based recommendations for the diagnosis and management of patients with NVO treated with antimicrobial therapy, with or without surgical intervention.

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Author and article information

Journal

Journal ID (nlm-journal-id): 9918335088006676

Journal ID (pubmed-jr-id): 51351

Journal ID (nlm-ta): Infect Dis Res

Journal ID (iso-abbrev): Infect Dis Res

Title: Infectious diseases research

ISSN (Electronic): 2703-4631

Publication date Nihms-submitted: 2 February 2022

Publication date (Print): 2022

Publication date (Electronic): 24 January 2022

Publication date PMC-release: 23 February 2022

Volume: 3

Issue: 1

Electronic Location Identifier: 3

Affiliations

[1 ]Department of Neurosurgery, University of Florida, Gainesville, Florida, the USA.

Author notes

[* ] Corresponding to: Brandon Lucke-Wold. Department of Neurosurgery, University of Florida, Gainesville, Florida, the USA. bwold@ 123456mix.wvu.edu .

Article

Manuscript ID: NIHMS1773960

DOI: 10.53388/idr20220117003

PMC ID: 8865404

SO-VID: fbfff930-c95e-478a-8ea9-4547bb259fb2

License:

This is an open access article under the CC-BY license. ( http://creativecommons.org/licenses/BY/4.0/)

Osteomyelitis of the spine: treatments and future directions

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Abstract

Background:

Methods:

Conclusion:

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Most cited references 66

Phage therapy in clinical practice: treatment of human infections.

Immunological mechanisms contributing to the double burden of diabetes and intracellular bacterial infections.

2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults.

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