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Back pain in the older patient.

Accepted for publication 9 January 1996 Clinical history A 72 year old male patient presented with recent onset thoracic back pain. The pain was continuous and intense, exacerbated by movements of the spine, and radiated bilaterally to the costal region. The patient was known to suffer from non-insulin-dependent diabetes mellitus and hypertension. On admission, he appeared unwell and had a fever of 37.5'C. Clinical examination revealed localised tenderness at the T7 level, with bilateral radicular dysaesthesia in the T7-8 area. Conventional radiographs of the thoracic spine were interpreted as showing diffuse idiopathic skeletal hyperostosis (DISH) and degenerative spondylosis (fig 1). The patient was treated with non-steroidal antiinflammatory drugs, acetaminophen, and muscle relaxants, with improvement of pain, and was discharged from the original admitting hospital three weeks later. Seven days after discharge, he was referred to our hospital because of an acute relapse of thoracic pain associated with febrile episodes. On examination, there was severe tenderness over T6-8, with hypoaesthesia in the T6-7 distribution bilaterally. There were no signs of