Spinal Osteomyelitis, Discitis, and Osteodiscitis

What it is

These are infections of the spine. Osteomyelitis is infection in the bone of a vertebra; discitis is infection in a disc; osteodiscitis (also called spondylodiscitis) is both together. The germs usually arrive through the bloodstream from an infection elsewhere, and sometimes after a procedure. It is uncommon but important, because an untreated spinal infection can damage bone and, rarely, threaten the nerves.

What it feels like

The classic clue is steadily worsening back or neck pain that does not ease with rest and is often worse at night — different from ordinary mechanical pain. Some people have fevers, chills, or night sweats, though not always. Because the pain can seem nonspecific at first, these infections are sometimes recognized later than we would like.

How we diagnose it

Blood tests that reflect inflammation, an MRI of the spine, and often a biopsy or blood cultures to identify the exact germ are the core of the workup. Pinning down the organism matters, because it tells us which antibiotic will actually work.

How we treat it

Most spinal infections are cured with a prolonged course of antibiotics — commonly around six weeks, often given through the vein — along with a brace for comfort and support while the spine heals. Surgery is reserved for specific problems: a collection of pus (an abscess) pressing on the nerves, an unstable or collapsing spine, or an infection that will not clear. The goal is to eradicate the infection and protect the spine and nerves.

The science — for the curious

Two principles guide care. First, identify the germ — treating blindly risks using the wrong antibiotic, so a biopsy or positive blood culture is worth the effort. Second, give the antibiotics enough time; spinal bone heals and clears infection slowly, which is why courses run for weeks, not days. Surgery is the exception, used when the infection has created a mechanical or neurological problem that antibiotics alone cannot fix.

Learn more

OrthoInfo — Low Back Pain: orthoinfo.aaos.org

OrthoInfo — Cervical Spondylosis (Arthritis of the Neck): orthoinfo.aaos.org

This handout is general education about a common condition and does not replace the personalized advice we discuss in clinic. If anything here does not match what we talked about, what we talked about wins — please ask me.