Spinal Infection

Spinal infection: discitis, osteomyelitis, and epidural abscess — rare but serious

⚠ Seek urgent medical assessment if you have back pain with:

Fever, night sweats, or feeling systemically unwell • Recent spinal injection, back surgery, or invasive procedure • History of intravenous drug use • Known infection elsewhere in the body • Immunosuppression (steroids, chemotherapy, HIV, diabetes) • Pain that is constant, severe, and not relieved by any position • Progressive neurological symptoms alongside the above features.

Rare
but serious — delayed diagnosis is associated with permanent neurological damage
Constant
pain not relieved by any position is the key differentiator from mechanical back pain
Fever
with back pain always requires urgent assessment to exclude infection

Types of spinal infection

Discitis
Infection of the intervertebral disc, usually from bacterial seeding via the bloodstream. Most commonly Staphylococcus aureus. Presents with severe back pain, fever, and elevated inflammatory markers.
Vertebral osteomyelitis
Infection of the vertebral body. May occur with or without discitis. Can cause vertebral collapse and spinal instability if untreated.
Epidural abscess
A collection of pus in the epidural space. Can cause rapid neurological deterioration from spinal cord compression. A surgical emergency when neurological deficit is present.
Spinal tuberculosis (Pott’s disease)
Haematogenous spread of tuberculosis to the spine. Important in patients from or with travel to endemic regions. Can cause progressive vertebral destruction.

Risk factors

  • Recent spinal surgery, injection, or lumbar puncture
  • Intravenous drug use — a major risk factor for haematogenous spinal infection
  • Diabetes mellitus — particularly poorly controlled
  • Immunosuppression: steroids, biologics, HIV, malignancy, chemotherapy
  • Known infection elsewhere: skin, urinary tract, dental, respiratory

Diagnosis and treatment

Diagnosis requires blood tests (CRP, ESR, blood cultures), MRI of the spine (the most sensitive investigation), and culture of the causative organism where possible. Treatment is with prolonged antibiotic therapy — typically 6–12 weeks — guided by the organism and its sensitivity. Surgery is required for neurological compromise, instability, or failure to respond to antibiotics.

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Download the Spinal Infection Fact SheetPDF — printable summary to share with your GP or practitioner

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