Spontaneous Incidence of Vertebral Body Infection Following Osteoporotic Vertebral Fracture

STUDY DESIGN: Retrospective case series. OBJECTIVE: The aim of this study was to examine the spontaneous incidence rate and features of pyogenic vertebral osteomyelitis in osteoporotic vertebral fracture (OVF). SUMMARY OF BACKGROUND DATA: Pyogenic vertebral osteomyelitis is a rare complication of OVF. We experienced some cases of vertebral body infection after OVF. METHODS: In this retrospective, single-center study, clinical data were collected by chart review. We examined the number of cases of pyogenic vertebral osteomyelitis following OVF between April 2014 and August 2018. Further, we examined the mechanism of injury, age, sex, duration from the diagnosis of OVF to the diagnosis of vertebral body infection, C-reactive protein level at the time of diagnosis of OVF, medical history, primary infection site, and serious events. RESULTS: The spontaneous incidence rate of complications was 0.7% (4/554). In all cases (two males and two females), fall history was present and vertebral body infection was not suspected to be present at the point of injury. The average age was 81.8 (range, 75-89, SD, 5.7) years. The average duration from the diagnosis of OVF to the diagnosis of vertebral body infection was 55.0 (range, 16-132, SD, 52.4) days. The average C-reactive protein level at the time of diagnosis of OVF was 11.5 (range, 0.5-29.7, SD, 12.7) mg/L. Medical history included rheumatoid arthritis (n = 1), diabetes mellitus (n = 1), malignant tumor (stage IV) (n = 1), and brain infarction (n = 2). The primary sources of infection were pneumonia (n = 3), and urinary tract infection (n = 1), and all patients experienced bacillemia at/after the diagnosis of fracture. All patients died due to septic shock. CONCLUSION: The spontaneous incidence rate of vertebral body infection among OVF patients was 0.7%; however, the occurrence of this complication led to serious events. Clinicians should pay attention to the possibility of bacillemia in elderly or immunocompromised OVF patients. LEVEL OF EVIDENCE: 4.