The majority of patients with a spinal infection are often diagnosed late because spine infection can present in many ways and mimic other conditions such as respiratory or bowel problems. In a review of 442 patients by Malawski and Lukawski (clinical Orthopaedics and Related research 1991) 47% of patients were diagnosed 1 year after the disease started. The most frequent incorrect diagnosis included brochopneumonia, meningitis, pancreatitis, radiculitis, appendicitis and acute abdomen. The consequences of incorrect diagnosis includes appendectomy operations, laparotomy, cholecystectomy as well as other unnecessary investigations.
Causes of a Spinal Infection
The majority of spinal infections have an undetected origin. It is however well known that bone infections occur as a result of dissemination of bacteria through the blood stream. Conditions that were identified as precursors to spinal infection were;
- Chronic Osteomyelitis (chronic bone infection) 22%
- Bronchopneumonia (Chest infection) 22%
- Purulent skin infections 13%
- Urinary tract infection 8%
- Purulent Appendicitis 8%
- Otitis Media (Middle ear infection) 5%
- Lumbar Puncture
- Injection of varicose veins
- GI or GUT Surgery
Symptoms of a Spinal Infection
Unfortunately spinal infection can present in many unusual ways. The reason for this is that nerves around the spine may refer the pain to other areas of the body and mimic other conditions such as hip pain or knee pain which is very common. Usually the main symptoms will include;
- Pain (Back pain or referred pain into abdomen, chest, or limbs) May also present with headache in the case of meningitis.
- Fever (Night sweats are common in TB and swinging fever is common in the presence of an abscess)
- Deformity of the spine (Usually a late feature when there has been sufficient destruction causing structural deformity). May also be due to intense pain and muscle spasm.
- Neurological Deficit. Nerve damage or spinal cord compression due to abscess or inflammation may lead to numbness or weakness in the limbs.