A decreased range of motion and signs of local infection may be seen in the affected area. Drainage is not usually seen. Blood cultures are positive in more than half of patients. Although in most children symptoms are present for 3 weeks or less, some children may present with vague symptoms of 1 to 3 months' duration. Vertebral osteomyelitis is a form of hematogenous osteomyelitis most commonly seen in older persons and I.V. drug abusers.
Most patients present with a constant dull pain that progresses slowly.
Percussion over the affected area usually causes intense pain. Neurologic signs are generally absent but when present may indicate an epidural abscess. Fewer than half of patients are febrile. The lumbar region is most frequently involved in pyogenic hematogenous osteomyelitis. These patients have recurrent episodes of clinical exacerbations that are usually more indolent than those seen in the acute episode.