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Vertebral osteomyelitis and discitis in adults

Malcolm McDonald, PhD, FRACP, FRCPA
Section Editor
Daniel J Sexton, MD
Deputy Editor
Elinor L Baron, MD, DTMH


Vertebral osteomyelitis most often occurs as a result of hematogenous seeding of one or more vertebral bodies from a distant focus [1]. Infection may also involve the adjacent intervertebral disc space, which has no direct blood supply in adults. Infection can also arise following surgery or injection of the disc space or via contiguous spread from adjacent soft tissue infection.

The terms vertebral osteomyelitis and discitis are often used interchangeably, and the diagnosis and management of the two entities are similar in most patients. The term pyogenic spondylitis refers to either vertebral osteomyelitis or discitis.

Pyogenic vertebral osteomyelitis will be reviewed here. Issues related to spinal epidural abscess and tuberculous spinal infections are discussed separately. (See "Spinal epidural abscess" and "Skeletal tuberculosis".)


Vertebral osteomyelitis is primarily a disease of adults; most cases occur in patients >50 years old [2]. The incidence increases with age. Men are affected approximately twice as often as women in most case series; the reason for this is not fully understood. Risk factors for vertebral osteomyelitis include injection drug use, endocarditis, degenerative spine disease, prior spinal surgery, diabetes, corticosteroid therapy, or other immunocompromised state.

The incidence of vertebral osteomyelitis is approximately 2.2/100,000 per year [3,4] and is likely increasing for the following reasons [1]:

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Literature review current through: Nov 2017. | This topic last updated: Jul 06, 2017.
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