[The radicular and pseudoradicular syndrome of infectious spondylitis and its differential diagnostic significance]

Infectious spondylitis is now the most common form of hematogenous osteomyelitis. In 37% of patients followed up it causes root irritation without peripheral paralysis, and radicular and pseudoradicular syndromes. Accounting for 8.2% of the cases, incomplete paraplegias are not as rare as is usually assumed. In certain sections of the spine infectious spondylitis is encountered very frequently (T7/8, T9/10, L3/4, and L4/5). The distribution pattern of the paralyses does not correspond to the frequency of the spondylitis in the individual segments of the spine. Radicular syndromes are more common in the lumbar spine, incomplete paraplegias in the thoracic spine. The neurologic risk depends on the patient's age: while very low in children, it is distinctly higher in patients aged over 70. Only the paraplegia risk is dependent on the extent of vertebral destruction. This in turn depends on the time that elapses until diagnosis. Almost all cases of spondylitis are still diagnosed unnecessarily late. Radicular and pseudoradicular symptoms accelerate diagnosis of spondylitis. Inflammatory and mechanical factors cause the radicular and pseudoradicular syndromes. Detection by radiologic examination is not usually possible. As regards formal pathogenesis, degenerative and inflammatory vertebragenous syndromes are indistinguishable, and spondylitis can only be clinically recognized from its general symptoms. No signs of paralysis occurred in any of the patients in whom spondylitis had been diagnosed in good time. Therefore, spondylitis diagnosis must also be improved in order to prevent neurologic complications.