Back pain is seldom serious but, nevertheless, is important because conditions such as infection are readily treatable. Some features that suggest serious back pain are shown.
Spinal infections include osteomyelitis, discitis and epidural abscess. Infections tend to affect the disc, while malignant processe affect the vertebra itself.
Discitis can be due to pyogenic organisms such as Staph. aureus, Mycobacterium tuberculosis or rare organisms such as Brucella.
X-RAYS AND BONE SCAN to confirm the diagnosis BLOOD COUNT-leucocytosis, high ESR
NEEDLE ASPIRATION of disc for culture
Immobilization in the acute stage and prolonged appropriate antibiotic therapy are required.
Bone metastases are classically from primaries in the bronchus, breast, kidney, thyroid or prostate. These are discussed on p. 432. Multiple myeloma produces osteolyticlesions of the spine . Primary tumours of the spinal cord rarely cause back pain