Infections

Spondylitis and diskitis - Pyogenic spondylitis

A localized pain complaint associated with a tense muscle containing a very tender spot, or trigger point, identifiable by palpation, which may be distant from the source of pain

Overuse injuries secondary to repetitive, unrepaired microtrauma are frequent, particularly in athletes engaged in high-impact sports

Immunocompromised and debilitated patients, drug abusers, diabetics, and alcoholics are at increased risk. Local spinal tenderness to percussion has an 80% sensitivity as a test for bacterial pyogenic infections, but a low specificity

Staphylococcus aureus is the most common organism, accounting for 60% of infections. Enterobacter accounts for 30%; other organisms are Escherichia coli, Salmonella, Pseudomonas aeruginosa, and Klebsiella pneumoniae

- Granulomatous and miscellaneous forms of spondylitis

- Fungal spondylitis

- Parasitic spondylitis

Epidural and subdural abscesses

Meningitis

Myelitis

Spinal tumors

Extradural spinal cord tumors (55%) - Metastatic (>70%)

Primary spinal cord tumors (30%)

Intradural spinal cord tumors (40%)

Granulomatous spondylitis: Mycobacterium tuberculosis most commonly involved; Brucella melitensis

Blastomycosis, aspergillosis, actinomycosis, cryptococcosis, and coccidioidomycosis. Echinococcus

Staphylococcus aureus is by far the most common organism

Spinal meningitis can be caused by bacterial, fungal, parasitic, or viral organisms, often as a manifestation of cerebral meningitis

Viral infections such as herpesvirus, coxsackievirus, and poliovirus are the most common organisms, and HIV-related myelitis has recently been increasing

Patients aged over 50 with unexplained weight loss and relentless pain lasting over four or five months (ranging from three days to over three years) who do not respond to bed rest or other conservative treatment

Lung (most common in men) Breast (most common in women) Lymphoma Prostate

Multiple myeloma (the most common bone tumor; 10-15%)

Osteogenic sarcoma (the second most common primary bone tumor in childhood and adolescence)

Chordoma

Chondrosarcoma

Ewing sarcoma

Giant-cell tumor

Benign bone tumors (osteoid osteoma, osteoblas-toma)

Meningioma

Nerve sheath tumors

Vascular malformations and tumors

Epidermoid and dermoid cysts and teratomas

Lipoma

Intramedullary spinal cord tumors (5%)

Ependymoma Astrocytoma

Metastases (carcinoma of the lung or breast, lymphoma, colorectal cancer) Hemangioblastomas Lipomas

Referred pain of visceral origin

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