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M46.2 – Osteomyelitis of the Spine
M46.2 is the ICD-10 code for osteomyelitis of the spine – a bacterial bone infection of the vertebrae that can cause severe back pain and neurological damage.
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M46.2 is the ICD-10 code for osteomyelitis of the spine – a bacterial bone infection of the vertebrae that can cause severe back pain and neurological damage.
What is M46.2 – Osteomyelitis of the Spine?
M46.2 is the ICD-10 code for osteomyelitis of the spine, also known as vertebral osteomyelitis or infectious spondylitis. It refers to a serious bacterial infection of the bone tissue affecting one or more vertebral bodies. The condition can be acute or chronic and requires prompt medical attention to prevent permanent damage.
Causes
Osteomyelitis of the spine is most commonly caused by bacteria that reach the vertebral bodies through the bloodstream (haematogenous spread). Less frequently, infections arise from direct spread from neighbouring tissues or as a complication of spinal surgery.
- Most common pathogen: Staphylococcus aureus (including MRSA)
- Other pathogens: Streptococci, gram-negative rod-shaped bacteria (e.g. Escherichia coli), Mycobacterium tuberculosis (in tuberculous spondylitis)
- Risk factors: Diabetes mellitus, immunodeficiency, intravenous drug use, dialysis dependency, previous spinal surgery, prolonged catheterisation
Symptoms
Symptoms may develop gradually and are often initially mistaken for ordinary back pain. Typical complaints include:
- Persistent, often severe back pain that does not improve at rest
- Fever and general malaise
- Local tenderness over the affected vertebrae
- Restricted spinal movement
- In severe cases: neurological deficits such as numbness, leg weakness, or bladder and bowel dysfunction (when the spinal cord is involved)
Diagnosis
Diagnosis is established through a combination of clinical examination, laboratory tests, and imaging:
- Blood tests: Elevated inflammatory markers (CRP, ESR, white blood cell count)
- Blood cultures: For pathogen identification
- MRI (Magnetic Resonance Imaging): Gold standard in imaging – detects bone and soft tissue involvement at an early stage
- CT-guided biopsy: For targeted pathogen sampling and antibiotic sensitivity testing
- Bone scintigraphy: Used as a complementary method in unclear cases
Treatment
Medical Treatment
Treatment primarily consists of a prolonged course of antibiotic therapy, ideally initiated after pathogen identification and sensitivity testing. The duration of therapy is typically 6 to 12 weeks, usually starting with intravenous antibiotics followed by oral continuation.
Surgical Treatment
Surgery is required in cases of:
- Neurological deficits due to spinal cord compression
- Abscess formation (e.g. epidural abscess)
- Spinal instability
- Failure of conservative treatment
Surgical procedures include abscess drainage, debridement of infected tissue, and if necessary, spinal stabilisation using implants.
Supportive Measures
Immobilisation of the spine using orthoses or bed rest may be necessary during the acute phase. Physiotherapy is recommended after the infection has resolved to restore mobility and strength.
Prognosis
With early diagnosis and consistent treatment, the prognosis is favourable in many cases. Late complications such as chronic back pain, spinal deformities, or neurological deficits are possible, particularly when the condition is diagnosed late. Mortality is higher in elderly or immunocompromised patients.
References
- Zimmerli W. - Vertebral Osteomyelitis. New England Journal of Medicine, 362(11):1022-1029, 2010. DOI: 10.1056/NEJMcp0910753
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) - Guidelines for the Diagnosis and Treatment of Vertebral Osteomyelitis, 2015.
- Lew D.P., Waldvogel F.A. - Osteomyelitis. The Lancet, 364(9431):369-379, 2004. DOI: 10.1016/S0140-6736(04)16727-5
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