||The presentation and clinical course for hematogenous
vertebral osteomyelitis and postoperative discitis is presented. The treatment
is primarily conservative care in the form of immobilization and parenteral
antibiotics. The indications for surgery are rare and should be reserved
for patients resistant to treatment or with septic course, abscess formation,
or neurologic deficits. In these cases, the infectious process has generally
involved the adjacent vertebrae or the neural elements. Surgery usually
involves an anterior approach. The principles of surgical treatment involve
debridement of necrotic tissue, decompression of neural elements, and stabilization
of the spine. The outcome of patients with vertebral osteomyelitis and secondary
discitis in general is favorable when appropriate treatment is rendered.
Extension of the infection to the spinal canal in the form of an epidural
abscess is also reviewed.