From the Guidelines
Lumbar osteomyelitis and discitis typically present with persistent back pain, localized tenderness, limited range of motion, and muscle spasms, along with elevated inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) 1. The most common symptom is persistent back pain that typically worsens at night and doesn't improve with rest. Patients often experience:
- Localized tenderness over the affected vertebrae
- Limited range of motion
- Muscle spasms in the lower back Fever is present in about 50% of cases, though it may be low-grade or intermittent. Neurological symptoms can develop if there is compression of the spinal cord or nerve roots, including:
- Weakness
- Numbness
- Tingling in the legs
- Bowel or bladder dysfunction in severe cases Laboratory findings typically show elevated inflammatory markers such as ESR and CRP. Some patients may report constitutional symptoms like:
- Fatigue
- Malaise
- Weight loss The onset is usually gradual rather than sudden, which can delay diagnosis. Risk factors include:
- Recent infections
- Intravenous drug use
- Diabetes
- Immunocompromised status
- Recent spinal procedures Early diagnosis is crucial as delayed treatment can lead to structural damage of the spine, chronic pain, and neurological deficits. The combination of back pain with elevated inflammatory markers should raise suspicion for this condition, especially in patients with risk factors 1. According to the most recent guidelines, MRI of the spine is the first diagnostic imaging of choice in patients with suspected lumbar osteomyelitis and discitis, with a sensitivity of 97%, specificity of 93%, and an accuracy of 94% in diagnosing the condition 1.
From the Research
Signs and Symptoms of Lumbar Osteomyelitis and Discitis
The signs and symptoms of lumbar osteomyelitis and discitis can be non-specific and may include:
- Back pain
- Fever
- Malaise
- Weight loss
- Neurological deficits, such as numbness, tingling, or weakness in the legs 2
- The onset of vertebral osteomyelitis is often insidious, making early diagnosis difficult 2
Diagnostic Challenges
- The clinical manifestations of vertebral osteomyelitis have low specificity, making early diagnosis challenging 2
- Magnetic resonance imaging (MRI) is the imaging method of choice for vertebral osteomyelitis and discitis, but it may show subtle, non-specific endplate subchondral changes in the early stages 3
- A repeat MRI examination may be required to show the typical features of vertebral osteomyelitis and discitis 3