Vertebral form of non-bacterial osteomyelitis: clinical and laboratory features and treatment characteristics

Abstract

Objective. To study clinical and laboratory features of spinal lesions associated with non-bacterial osteomyelitis (NBO), to define the role of surgery in its diagnosis and treatment, and to analyze the efficacy of different treatment regimens. Material and Methods. Retrospective two-center cohort of 54 children with NBO, including 18 patients with vertebral le- sions was studied. The level of evidence is 3. Results. Vertebral form of the non-bacterial osteomyelitis is characterized by high frequency of multifocal bone lesions. The features of clinical and X-ray manifestations of the vertebral form of NBO, its diagnosis and medical treatment are presented. First of all NBO should be differentiated from infectious (tuberculosis) and neoplastic lesions of the skeleton. Non-steroid anti-inflammatory drugs are not effective for the relief of pain in the NBO vertebral form, preference should be given to bisphosphonates and TNF-a inhibitors. Indications and volume of surgical techniques for diagnosis and treat- ment of this pathology are specified. Conclusion. Management of patients with the vertebral form of NBO should be interdisciplinary and carried out with the assistance of doctors of various specialties – pediatricians, rheumatologists, orthopedists, surgeons, phthisiatrician, etc.

Keywords

• non-bacterial osteomyelitis
• chronic recurrent multifocal osteomyelitis
• spine
• treatment
• bisphosphonates
• tnf-inhibitors