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Pyogenic vertebral osteomyelitis. Treatment with antimicrobial agents and bed rest.

Four patients were treated with antibiotics and simple bed rest for pyogenic vertebral osteomyelitis. The initial clinical response to therapy was good in all patients, with a rapid fall in temperature and a marked decrease in back pain within two or three days. The duration of hospitalization averaged 42 days and all four patients were ambulatory when discharged. Spontaneous intervertebral fusion occurred in three patients and all have returned to work. The duration of follow-up has ranged from 17 to 30 months and no relapses or complications have occurred. The fourth patient died of a myocardial infarction ten days after discharge. At autopsy, the vertebral bodies and disk space were sterile and reparative bony sclerosis had begun. In these four cases, the clinical response to bed rest and antibiotics was equivalent to that obtained with rigid immobilization. This regimen avoids the inconvenience and hazards of body casts and the duration of hospitalization may be shortened.