Rapid bony destruction with pyogenic vertebral osteomyelitis.

We report the case of a previously healthy woman who had an extremely rapid progression of pyogenic vertebral osteomyelitis. The plain film radiographs from 1 month before admission, from the time of admission, and from her 1 year follow-up are presented. Although it is a well known fact that pyogenic vertebral osteomyelitis can evolve rapidly and that the radiographic images often lag behind the clinical symptoms, it is rare to find a case with such clear radiographic documentation. A film that was interpreted as having mild arthritic changes, 1 month before admission, progressed to one that demonstrates severe bony destruction with a kyphotic angulation of 90 degrees. The current methods of diagnosis and treatment of pyogenic vertebral osteomyelitis are reviewed.