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