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Original ArticleOpen Access
Misdiagnosis in Vertebral Osteomyelitis : Problems and Factors
Buranapanitkit Bi 
,
Lim A ,
Geater A
,
Lim A ,
Geater A BOONSIN BURANAPANITKIT, M.D.*,
APIRADEE LIM, B.Sc. **,
ALAN GEATER, Ph.D.**
One hundred and one cases diagnosed with vertebral osteomyelitis were evaluated for mis-
diagnosis and both factors and outcomes of misdiagnosis were assessed. There were 67 patients
with tuberculous spondylitis and 34 patients with pyogenic vertebral osteomyelitis. Misdiagnosis
occurred in 33.7 per cent of the cases. The average delayed diagnosis time was 2.6 months (range,
0.2 to 12). Age between 60 to 70 years was the most frequent group for misdiagnosis, while the
most frequent area of misdiagnosis was the lumbar spine. Metastatic carcinoma, spinal stenosis,
herniated nucleus palposus and back strain were common initial misdiagnoses. The factors, age
group, absence of fever and positive straight leg raising test (SLRT) were associated with misdiag-
nosis in univariate analysis and multivariate analysis (odds ratio 3.40 (95%CI: 1.07-11.94 ), 3.47
(95%CI: 1.20-10.05), and 24.47 (95%CI:2.18-274.28), respectively) Misdiagnosis was statistically
significantly associated with the result of treatment. This paper emphasizes that the elderly age
group, absence of fever and positive SLRT are the independent factors which increase the risk of
misdiagnosis of vertebral osteomyelitis.
Key word : Misdiagnosis, Vertebral Osteomyelitis
APIRADEE LIM, B.Sc. **,
ALAN GEATER, Ph.D.**
One hundred and one cases diagnosed with vertebral osteomyelitis were evaluated for mis-
diagnosis and both factors and outcomes of misdiagnosis were assessed. There were 67 patients
with tuberculous spondylitis and 34 patients with pyogenic vertebral osteomyelitis. Misdiagnosis
occurred in 33.7 per cent of the cases. The average delayed diagnosis time was 2.6 months (range,
0.2 to 12). Age between 60 to 70 years was the most frequent group for misdiagnosis, while the
most frequent area of misdiagnosis was the lumbar spine. Metastatic carcinoma, spinal stenosis,
herniated nucleus palposus and back strain were common initial misdiagnoses. The factors, age
group, absence of fever and positive straight leg raising test (SLRT) were associated with misdiag-
nosis in univariate analysis and multivariate analysis (odds ratio 3.40 (95%CI: 1.07-11.94 ), 3.47
(95%CI: 1.20-10.05), and 24.47 (95%CI:2.18-274.28), respectively) Misdiagnosis was statistically
significantly associated with the result of treatment. This paper emphasizes that the elderly age
group, absence of fever and positive SLRT are the independent factors which increase the risk of
misdiagnosis of vertebral osteomyelitis.
Key word : Misdiagnosis, Vertebral Osteomyelitis
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