Spontaneous Vertebral Osteomyelitis Mimicking Spinal Tumor: A Rare Cause of Complete Paraplegia and Rehabilitation Challenges

Spontaneous vertebral osteomyelitis (SVO) is a rare but severe spinal infection that often presents with non-specific back pain, leading to misdiagnosis as a neoplastic disease. A 53-year-old female presented with progressive lower back pain, rapidly developing sudden complete paraplegia and neurogenic bowel/bladder. Initial MRI revealed T4–T6 vertebral lesions mimicking a spinal tumor. Emergent surgery and cultures confirmed Escherichia coli vertebral osteomyelitis. Following decompression and targeted antibiotic therapy, a cautious, phase-specific rehabilitation program was initiated. Given the persistent infection and spinal instability, all weight-bearing activities were deferred until infection control and structural stability were confirmed following a spinal fixation surgery. The patient required long-term intensive rehabilitation to facilitate functional adaptation. This case highlights the diagnostic challenges of SVO. Delayed diagnosis can result in significant neurological deficits and spinal instability. Crucial imaging differentiation relies on specific features: spinal infections typically involve the intervertebral disc, exhibit endplate irregularity, and form paraspinal or epidural abscesses, whereas neoplasms usually spare the disc and cause focal marrow replacement. Timely intervention and individualized, phase-specific rehabilitation focusing on spinal stability, are essential for optimizing functional recovery.