Vertebral Osteomyelitis and Tuberculosis

Osteomyelitis, mainly after a fracture, is a disease that has been described since Hippocrates (460–370 BC). Acute hematogenous osteomyelitis, in its term, was only much later described in 1773, by Bromfield, as bone that “may become carious, first in its internal parts and that from external injury, as well as from a vitiated state of the animal fluids.” He called this an abscessus in medulla, and advised to drain the infected bone as soon as possible. The first published paper on the theme dates back to 1948, already showing a massive difference in prognosis after the advent of penicillin, with deadly incidence reducing from 33% to 10% after 1940, although the treatment—both surgical and clinical—was still very erratic at the time. Over 2000 years have passed since Hippocrates, some 250 since Bromfield and another 80 since penicillin started being used. The treatment basis for this disease remains mainly unaffected, with proper antibiotic therapy and mechanical debridement being the most important parts of it, to this day.