Spinal Infection (Osteomyelitis & Discitis)

Spinal infections are uncommon but serious. They can affect the vertebrae (osteomyelitis), the discs between them (discitis), or the space around the spinal cord (epidural abscess). Modern imaging and antibiotics have greatly improved outcomes, but early recognition is critical.

What's happening in your spine

Bacteria or, less commonly, fungi can reach the spine through the bloodstream, after a spine procedure, or by spreading from a nearby infection. Once established, the infection can destroy bone and disc tissue and, in some cases, form a pocket of pus that presses on the spinal cord or nerve roots.

Common symptoms

• Constant, severe back or neck pain — often worse at night and not relieved by rest
• Fever, chills, night sweats, or unexplained weight loss
• Tenderness directly over the spine
• New weakness, numbness, or trouble walking
• Loss of bowel or bladder control (a surgical emergency)
• Recent infection elsewhere in the body, IV drug use, recent spine procedure, or weakened immune system

Causes & risk factors

The most common organism is Staphylococcus aureus. Risk is higher in patients with diabetes, dialysis, IV drug use, cancer or chemotherapy, long-term steroid use, recent spine surgery or epidural injection, or a recent bloodstream infection.

How it's diagnosed

Workup includes blood tests for inflammation (CRP, ESR), blood cultures, and MRI of the spine, which is the most sensitive imaging test. CT and X-rays may be added. A CT- or fluoroscopy-guided biopsy is often used to identify the specific organism before starting long-term antibiotics.

Treatment options

Most spinal infections are treated with antibiotics, close monitoring, and supportive care.

• Targeted intravenous antibiotics (or antifungals), typically for 6–8 weeks
• Bracing for comfort and stability while the infection heals
• Pain management and treatment of underlying conditions such as diabetes
• Serial blood tests and imaging to confirm response
• Coordination with infectious disease specialists

Surgery is recommended when there is significant nerve or spinal cord compression, a large abscess, spinal instability, severe pain or deformity, or when antibiotics alone are not controlling the infection. Procedures may include drainage of an abscess, removal of infected tissue, and stabilization.

When to see a specialist

Seek immediate evaluation for severe new back pain with fever, rapidly worsening weakness or numbness, or any loss of bowel or bladder control. Patients with risk factors and unexplained back pain should be evaluated promptly even without fever.