What is the classic sequence of infection spread in spinal osteomyelitis?

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Multiple Choice

What is the classic sequence of infection spread in spinal osteomyelitis?

The infection in spinal osteomyelitis usually seeds the vertebral endplates first and then invades the adjacent intervertebral disc, rather than starting in the disc or in the posterior elements. Hematogenous spread tends to lodge in the anterior subchondral region of a vertebral endplate because of its rich blood supply near the disc, and from there the bacteria erode through the endplate into the disc, causing discitis with loss of disc space. This sequence explains why disc space narrowing accompanies earlier endplate destruction. Other patterns—disc space infection as the initial site, infection starting in the posterior elements, or primary epidural space involvement with compression—don’t fit the typical hematogenous spread and progression seen in spinal osteomyelitis.

The infection in spinal osteomyelitis usually seeds the vertebral endplates first and then invades the adjacent intervertebral disc, rather than starting in the disc or in the posterior elements. Hematogenous spread tends to lodge in the anterior subchondral region of a vertebral endplate because of its rich blood supply near the disc, and from there the bacteria erode through the endplate into the disc, causing discitis with loss of disc space. This sequence explains why disc space narrowing accompanies earlier endplate destruction.

Other patterns—disc space infection as the initial site, infection starting in the posterior elements, or primary epidural space involvement with compression—don’t fit the typical hematogenous spread and progression seen in spinal osteomyelitis.

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