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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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