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Less Is More
February 2014

Follow-up Imaging for Vertebral OsteomyelitisA Teachable Moment

Author Affiliations
  • 1Currently a medical student, School of Medicine, University of California, San Francisco
  • 2Division of Infectious Diseases, San Francisco General Hospital, San Francisco, California
JAMA Intern Med. 2014;174(2):184. doi:10.1001/jamainternmed.2013.12742

Mr X was unexcited about repeat neck surgery on his 55th birthday, especially when, all things considered, he was feeling fine. He came to our hospital for a routine follow-up magnetic resonance imaging study. He had experienced long-standing severe cervical stenosis. After a curative laminectomy 5 months ago, he developed cervical osteomyelitis with a prevertebral abscess. The follow-up magnetic resonance imaging study had been ordered to determine whether the abscess had resolved after 6 weeks of targeted antibiotic therapy. He was feeling well and so was particularly nonplussed when he was suddenly rushed from the scanner to the emergency department, admitted, and scheduled for an urgent surgical washout procedure. Although the follow-up scan showed resolution of the prevertebral abscess, it also revealed increased bony destruction of his cervical vertebrae. The conclusion was that his antibiotic treatment must have failed and the osteomyelitis had progressed.

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