Clinical manifestations of acute hematogenous osteomyelitis of the spine are more difficult to define. The patient may complain of a vague backache as well as generalized malaise, decreased appetite, and fever. Pain restricts the active range of motion of the back, and gentle percussion over the spinous processes often causes significant discomfort. This constellation of symptoms is not specific to osteomyelitis, and diagnosis of osteomyelitis may often be overlooked in the many patients who complain of backache. Frequently, osteomyelitis of the spine is secondary to a urinary tract infection. Therefore, a recent history of infection or surgical manipulation of the urinary tract should heighten the clinical suspicion of a secondary infection of the spine.