Spinal infection is a rare cause of back pain that can have devastating consequences if left untreated. Since back pain can be the only symptom in early spinal infection diagnosing it is a major challenge in primary care, where back pain accounts for 6-9% of consultations. Most episodes of back pain, which has an annual incidence of 2-5%, are mechanical in nature and are self-limiting. Only a small proportion of back pain is due to serious underlying causes such as infection, neoplasia and fractures. GPs need to be aware of the presenting symptoms of spinal infection and who is at risk, as a high index of suspicion is needed to avoid the significant morbidity and mortality associated with delayed diagnosis. Spinal infection is a spectrum of infection involving bones, disc and/or ligaments, see Figs 1 to 3. It is an ancient entity reported in Egyptian mummies and even in the Iron Age. Sir Percival Pott first described tuberculous infection of the spine in his monograph in 1779, and French physician Lannelonge first described pyogenic osteomyelitis in 1879. Globalisation, an increased life expectancy, an increase in the high-risk population, spinal instrumentation and advanced imaging techniques have led to a rising incidence of spinal infections (Duarte and Vaccaro, 2013). Due to the low specificity of signs and insidious onset of symptoms there is often a delay in diagnosis and treatment.
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