Occult
infections caused by indolent organisms may produce persistent
back pain that may be difficult to diagnose. The usual findings considered indicative of spinal
infection are not reliable in these cases. The authors describe nine patients who presented with occult
infections of the lumbar spine. Two of the nine had no antecedent lumbar surgeries nor open
wounds. The predominant organisms were diptheroids and
coagulase-negative staphylococci. The diagnosis was established by the
clinical course, pathologic tissue changes at surgery, cultures, and response to
antibiotic therapy. Normal Westergren sedimentation rates were noted in seven of nine patients, and normal white blood cell counts in six of nine patients. With the exception of two positive computed tomography (CT) scans, one positive
gallium scan, and one positive magnetic resonance imaging (MRI) scan, all remaining imaging studies were negative for
infection. In many cases, the
infection neither was limited to nor involved the disc space.