Infection
Osteomyelitis and/or discitis will cause sudden or gradual appearance of
back pain that can be on different levels and of various severities, and
may be accompanied by fever and chills. The pain will be constant and
include night pain, and it might worsen over time without
treatment.27 In children, spondylodiscitis can present
with gait abnormalities or abdominal pain without back
pain.28 An epidural abscess will cause a turbulent
illness with severe pain, fever, chills, and progressive neurological
deficiency caused by cord or cauda compression. If the patient is
partially treated the clinical picture may be deceivingly less
severe.29 A paraspinal abscess can cause prolonged
fever even without pain, or pain that radiates to the groin along the
psoas muscle.6 Fungal infections of the spine appear
most often in immunosuppressed patients, and will cause back pain with
various neurological abnormalities because of cord or nerve root
compression.4 Brucellosis causes a systemic illness
with fever and muscle and bone pain, including spinal involvement with
micro abscesses of the vertebra.29 Gonorrhea can cause
meningitis of the cord, especially in immunosuppressed
individuals.30 Syphilis causes Charcot arthropathy of
the spine and (rarely) a gumma in the spinal canal that can compress the
cord or the nerve roots.31 Tuberculosis of the spine
causes a slowly progressing illness, back pains, and deformity with
various neurological abnormalities.29 Spinal hydatid
disease (Echinococcus granulosus) is rare: its manifestations are
radiculopathy, myelopathy, and/or local pain due to bony destructive
lesions, pathological fracture, and consequent cord
compression.29 Herpes zoster causes suddenly appearing
back pain that radiates to the chest or the abdomen 2 or 3 days before
the appearance of the typical herpetic vesicles (the rash will not
appear at all in some cases [zoster sine
herpete]).14 Various viral diseases, such as
influenza, can cause back and bone pain that might appear before the
fever and other systemic signs.14 A Coxsackie-B virus
infection causes severe chest and back pain (“devil’s
grip”).32 Poliomyelitis, tetanus, and rabies can also
cause back pain and should be considered.33,34 Acute
flaccid myelitis causes fever, neck and back pain with flaccid motor
paralysis of various severities, with minimal sensory symptoms, cranial
nerve involvement is possible.35