6 Clinical Picture

Clinical picture
CLINICAL PICTURE
SYMPTOMS:
The symptoms of spondylodiscitis are non-
specific. The onset of symptoms is insidious and often
underestimated by the patient. The presentations may
vary according to location (Cone et al., 2010).
In more than 90% of patients, unremitting back or
neck pain which is not relieved by rest is the most
common presenting complaint (Mann et al., 2012).
Radicular pain (50-93%) radiating to the chest or
abdomen is not uncommon and may lead to
misdiagnosis or even unnecessary surgery (Beronius et
al., 2011).
Some authors report the presence of fever in 10-
45% of patients, even in pyogenic osteomyelitis (Butler
et al., 2010). It is more common in brucellosis; this fact
frequently allows clinicians to suspect the possibility of
infection (Jaramillo-de la Torre et al., 2009).
The absence of fever was significantly more
frequent in spinal tuberculosis, with a greater presence
of spinal deformity. The latter is in close relation with
the considerable destructive character of caseating
granuloma and is an important diagnostic clue
(Buranapatikit et al., 2010).
68
Clinical picture
Pain may be accompanied by constitutional

symptoms including: Loss of weight, Poor appetite and
Cachexia which may be mistaken as malignancy.
Generalized lymphadenopathy is suggestive of HIV
infection (Martín et al., 2010).
Cervical spondylodiscitis may manifest with
dysphagia or torticollis (Schimmer et al., 2009).
In children; Symptoms of spondylodiscitis are
non-specific and include: Irritability, Limping, Refusal
to crawl, sit or walk and Hip pain. The child may
assume a flexed position. Those with involvement of the
dorsolumbar spine may develop abdominal pain.
Incontinence may be a presenting feature (Brown et al.,
2007 and Kayser et al., 2009).
Compared with adults, children are less likely to
have co-morbidities and neurological deficits are
uncommon. The diagnosis is frequently more delayed
(Fernandez et al., 2011).
Neurological deficits including; leg weakness,
paralysis, sensory deficit, radiculopathy and sphincter
loss, are present in a third of cases and have higher
incidence in cervical spine compared to dorsal or
lumbar spine (Schimmer et al., 2009 and Mylona et al.,
2011).
69
Clinical picture
Karadimas et al., 2012 reported an incidence of

neurologic deficit only13.5% in series of 163 patients,
while Citak et al., 2011 performed a retrospective study
on 183 cases of spondylodiscitis and the incidence of
neurological deficits was as high as 43.7%.
Neurological deficit (in particular, paralysis) are
frequently associated with complications especially,
epidural abscesses (Wirtz et al., 2007). Risk factors for
paralysis also include diabetes mellitus, advanced age,
rheumatoid arthritis, staph.aureus and steroid use
(Belzunegui et al., 2012).
Sensory involvement is less common than motor
and long-tracts signs because compression is primarily
anterior (Pigrau et al., 2005).
An ischaemic mechanism has been proposed
resulting from occlusion of the blood flow to the spinal
cord, thrombosis of the venous drainage system or an
abscess-induced vasculitis. However, it is likely that the
primary aetiology of neural damage is mechanical
compression with vascular compromise playing a
secondary role (Hadjipavlou et al., 2010).
70
Clinical picture
SIGNS:
Spinal tenderness is the commonest sign detected
on examination, reported in 78–97% of cases. Restricted
range of movement and paravertebral muscle spasm are
commonly noticed (Euba et al., 2008).
Spinal deformity, predominantly kyphosis and
gibbus formation, are commoner in tuberculous
spondylodiscitis. Untreated chronic infections can
progress to sinus formation, subcutaneous abscesses
which have a rare occurrence in recent case series
(Chang et al., 2013).
A positive straight leg raising test is present only
in a few percent of the patients (Euba et al., 2008).
In chidren: loss of lumbar lordosis and lower
back movement is the commonest sign on examination
(Rasool, 2011).
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6 Clinical Picture

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Clinical picture

Pain may be accompanied by constitutional

Karadimas et al., 2012 reported an incidence of

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