Misdiagnosis in vertebral osteomyelitis: problems and factors.

One hundred and one cases diagnosed with vertebral osteomyelitis were evaluated for misdiagnosis and both factors and outcomes of misdiagnosis were assessed. There were 67 patients with tuberculous spondylitis and 34 patients with pyogenic vertebral osteomyelitis. Misdiagnosis occurred in 33.7 per cent of the cases. The average delayed diagnosis time was 2.6 months (range, 0.2 to 12). Age between 60 to 70 years was the most frequent group for misdiagnosis, while the most frequent area of misdiagnosis was the lumbar spine. Metastatic carcinoma, spinal stenosis, herniated nucleus palposus and back strain were common initial misdiagnoses. The factors, age group, absence of fever and positive straight leg raising test (SLRT) were associated with misdiagnosis in univariate analysis and multivariate analysis (odds ratio 3.40 (95%CI:1.07-11.94), 3.47 (95%CI:1.20-10.05), and 24.47 (95%CI:2.18-274.28), respectively) Misdiagnosis was statistically significantly associated with the result of treatment. This paper emphasizes that the elderly age group, absence of fever and positive SLRT are the independent factors which increase the risk of misdiagnosis of vertebral osteomyelitis.

Clinical manifestation of tuberculous and pyogenic spine infection.

The authors compared clinical and baseline parameters between patients with tuberculous spondylitis (67 patients) and pyogenic vertebral osteomyelitis (34 patients). The average age was 50.8 (range, 1 to 82 years). Males were slightly more predominant in both pyogenic and tuberculous infections. Seventy per cent of patients with pyogenic infection had had symptoms for less than 3 months, while this was the case for only 44 per cent of the tuberculous patients. Lumbar spine was the most common site of involvement. Associated infections were more commonly found in tuberculous infection. Thirty per cent of tuberculous spondylitic patients were initially misdiagnosed, while 44 per cent of patients with pyogenic vertebral osteomyelitis had delayed diagnosis. Only 20 per cent and 30 per cent of tuberculous and pyogenic patients had fever, respectively. Neurological deficit occurred more frequently in pyogenic than in tuberculous infection (79% vs 59%), while bowel bladder involvement was more commonly found in tuberculous spondylitis. Kyphosis was significantly more common in tuberculosis than in pyogenic infection (50.8% vs 26.5%, respectively). Sinus tract formation, subcutaneous abscess formation and positive for SLRT (straight-leg-raising test) were found in only a small percentage of the patients. Duration of symptoms, site, associated infection, kyphosis and neurological deficit could be used for differentiation of spinal infection.