Spine Case 11 History/Physical Exam

Vertebral osteomyelitis and discitis

There is no typical presentation for vertebral osteomyelitis. Most patients describe the insidious onset of spinal pain that gets worse over weeks to months. Fever is only seen in approximately 50% of patients. Therefore, it is important to maintain a high index of suspicion in patients at risk, particularly older patients with recent GU manipulation, sacral ulcerations, indwelling lines, or immune compromise. Physical examination often reveals pain with palpation and percussion of the spine. Neurologic exam may be normal.