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Old 06-27-2012
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Rheumatology/Orthopedics Management of Vertebral Osteomyelitis?

A 58-year old man is evaluated in the emergency department for severe low back pain of 3 week's duration. The patient
reports no recent trauma but has felt feverish. He has no radicular symptoms and reports no bowel or bladder
incontinence. He is a current smoker and active user of illicit intravenous drugs.
On physical examination, temperature is 38.9C (102.0F), blood pressure is 140/90 mm Hg, pulse rate is 100/min, and
respiration rate is 14/min. Multiple needle marks are noted on the arms and legs. He has tenderness over the first and second lumbar vertebrae. Upper and lower extremity motor strength and sensation are normal as are the tendon reflexes. Anal sphincter tone is normal. Lower extremity and perianal sensation is intact.
Leukocyte count is 8000/μL (8 109/L). Erythrocyte sedimentation rate is 110 mm/h.

Which of the following is the most appropriate management?

(A) Empiric antibiotic therapy
(B) Spine CT
(C) Spine MRI
(D) Spine x-ray
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Old 06-27-2012
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(C) Spine MRI
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Old 06-27-2012
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Isnt Xray better for osteomyelitis?

I would go with A.
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Quote:
Originally Posted by tyagee View Post
A 58-year old man is evaluated in the emergency department for severe low back pain of 3 week's duration. The patient
reports no recent trauma but has felt feverish. He has no radicular symptoms and reports no bowel or bladder
incontinence. He is a current smoker and active user of illicit intravenous drugs.
On physical examination, temperature is 38.9C (102.0F), blood pressure is 140/90 mm Hg, pulse rate is 100/min, and
respiration rate is 14/min. Multiple needle marks are noted on the arms and legs. He has tenderness over the first and second lumbar vertebrae. Upper and lower extremity motor strength and sensation are normal as are the tendon reflexes. Anal sphincter tone is normal. Lower extremity and perianal sensation is intact.
Leukocyte count is 8000/μL (8 109/L). Erythrocyte sedimentation rate is 110 mm/h.

Which of the following is the most appropriate management?

(A) Empiric antibiotic therapy
(B) Spine CT
(C) Spine MRI
(D) Spine x-ray
maybe C.......????.
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Old 06-28-2012
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Conrad Fischer Algorithm for the management of osteomyelitis:

1. Best initial step: X-ray. If xray is positive proceed to 2. If xray is negative, proceed to 4.
2. Bone biopsy: should be done through uninfected tissue. Obtained material should be gram stained and cultured.
3. Empiric management prior to obtaining culture result: In this pxt with a history of IV drug abuse, MC organism: Staph aureus. DOC: Oxacillin, cefazolin or ceftriaxone.
4. MRI: an mri should be done if xray result is negative. If mri is contraindicated, a bone scan should be done instead
5. definitive therapy: change antibiotic appropriately based on result of culture when available.
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This is not your typical garden variety osteomyelitis......this is vertebral osteomyelitis in which early and accurate diagnosis is a priority. This patient is at risk of developing spinal cord compression so an MRI is the most appropriate step.
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Quote:
Originally Posted by Novobiocin View Post
This is not your typical garden variety osteomyelitis......this is vertebral osteomyelitis in which early and accurate diagnosis is a priority. This patient is at risk of developing spinal cord compression so an MRI is the most appropriate step.
what would be ans to the best initial test in vertebral osteomyelitis ? i think then it can be x-ray
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