1. Pyogenic Spinal Infections
Pyogenic Spondylitis: Body involvement , starting in the endplates.
Septic intervertebral discitis
Spinal Epidural abscess

2. Presentation Acute Sub-acute - common. Chronic - common
Average delay in diagnosis : 8 weeks to 3 months.

3. Presentation Usually have underlying infection source.
C/o Back Pain - similar to mechanical LBP.
Fever: Only 33% >100F( Garcia, JBJS 1960)
Local tenderness may or may not be present.
Muscle spasm +/- , Psoas Abscess
Neurology in late cases.
Symptoms much more than examination findings may suggest

4. Diagnosis Need a high index of suspicion.
ESR/CRP - usually high - but non-specific.
Bone scan - May be false negative( disc avascular). Or may show ‘degenerative change’ only.
MRI - Best. High signal on T2 image .
WBC count - unhelpful
Blood cultures - during fever spike. +/-.

5. Diagnostic pitfalls No fever, no local tenderness.
ESR high due to other causes.
Bone scan negative.
Referred pain - abdomen,’hip’, chest.
May present with worsening of long standing mechanical low back pain.
First pass investigations may be negative in early disease.

6. Predisposing factors Diabetes Rheumatoid Arthritis
Other infections - urinary, chest, septicemia.
I/V drug abuser
Anti-cancer treatment
Long term steroid use.

7. Mangement Confirm diagnosis WBC, ESR, Blood Culture.
Percutaneous washout and biopsy in selected cases.
Antibiotics for 3 months usually

8. Organisms Commonest is Staph. Aureus.
Pseudomonas in immuno-compromised hosts.
Could be Candida or TB.