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Osteomyelitis of the spine

Spinal Osteomyelitis: Treating a Bone Infection in the Spine

Back pain that’s constant, worse at night, and comes with fever, chills or feeling unwell can be a sign of infection in the spine. Caught early, most spine infections are cured with antibiotics.

What Is Spinal Osteomyelitis?

Spinal (vertebral) osteomyelitis is an infection in one or more bones of the spine. It usually starts when bacteria travel through the bloodstream from an infection elsewhere in the body, such as the skin, urinary tract, lungs or heart valves, and settle in the spine. The infection often involves the disc between two vertebrae as well (discitis).

Illustration of the lumbar spine showing vertebrae, discs and nerve roots
Image: Blausen Medical, CC BY 3.0 (source)

Most spine infections are treated with several weeks of antibiotics. Surgery is needed when the infection forms an abscess, damages the bone enough to make the spine unstable, presses on the nerves or spinal cord, or doesn’t respond to antibiotics. In those cases, surgery can often correct the problem.

What Causes Spinal Osteomyelitis

  • Bacteria in the bloodstream, most often Staphylococcus aureus (staph)
  • Infections elsewhere: skin, urinary tract, lungs, teeth or heart valves
  • Recent spine surgery or injections (postoperative infections)
  • Less commonly, tuberculosis or fungal infections

Risk Factors

  • Diabetes
  • Kidney disease and dialysis
  • IV drug use
  • A weakened immune system, including from cancer treatment or long-term steroids
  • Older age
  • Recent infection, surgery or catheter use

Symptoms

Common symptoms

  • Constant back or neck pain that doesn’t improve with rest and is often worse at night
  • Tenderness over the spine
  • Fever, chills or sweats (though many patients have no fever)
  • Fatigue and unexplained weight loss

Warning signs of a more serious infection

  • Weakness or numbness in the arms or legs
  • Bladder or bowel changes
  • Severe, worsening pain

When it’s an emergency: Fever with severe back pain, new weakness or numbness, or bladder or bowel changes need emergency care. Call 911 or go to the nearest emergency room.

How We Diagnose Spinal Osteomyelitis

  • Blood tests: markers of inflammation (ESR and CRP), white blood cell count and blood cultures
  • MRI with contrast: the best test to show infection in the bone and disc and any abscess
  • CT scan: shows bone destruction and helps plan biopsy or surgery
  • Biopsy: a CT-guided needle sample identifies the exact germ so the right antibiotic can be chosen
Imaging showing discitis, an infection of a spinal disc
Image: Hospital for Sick Children, CC BY-SA 3.0 (source)

Treatment Options

Antibiotics

Most patients are treated with antibiotics for at least six weeks, often starting through an IV, in coordination with an infectious disease specialist. A brace may be used for comfort and support. Blood tests and imaging track how the infection is responding.

When surgery makes sense

Surgery is recommended when there is an abscess, pressure on the spinal cord or nerves, spinal instability or deformity, or an infection that isn’t clearing with antibiotics. Surgery can often correct the problem by:

  • Debridement: removing infected tissue and draining any abscess
  • Decompression: relieving pressure on the spinal cord or nerves
  • Stabilization: rebuilding and fusing the spine when infection has damaged the bone, sometimes including a vertebral corpectomy

What to Expect

Treatment course

Antibiotic treatment usually lasts six weeks or longer. Many patients receive IV antibiotics at home or at an infusion center through a long-term IV line.

Recovery timeline

  • Weeks 1-6: antibiotics, pain control and gradual walking
  • Weeks 6-12: follow-up blood tests and imaging to confirm the infection is clearing
  • Months 3-12: bone healing and return to normal activities

Frequently Asked Questions

How did I get an infection in my spine?

Usually bacteria from another infection travel through the bloodstream and settle in the spine. Sometimes the original source is never found.

Can I have a spine infection without a fever?

Yes. Many patients don’t have a fever, which is why persistent, worsening back pain with risk factors should be evaluated.

Will I need surgery?

Many patients are cured with antibiotics alone. Surgery is for abscesses, nerve compression, instability or infections that don’t respond.

How long will I be on antibiotics?

Usually at least six weeks, sometimes longer depending on the germ and how you respond.

Can the infection come back?

It can, which is why completing the full antibiotic course and follow-up testing are important.

Concerned About an Infection After Surgery?

If you’ve had spine or brain surgery and notice fever, chills, redness, swelling or drainage from your incision, or pain that is getting worse instead of better, call the surgeon who performed your operation right away. If you can’t reach them, or you have new weakness or numbness, confusion, a stiff neck with severe headache, or bladder or bowel changes, go to the nearest emergency room or call 911.

This page is for educational purposes only and is not a substitute for medical advice. If you have fever with severe back or neck pain, sudden weakness, numbness in the groin, or bladder or bowel changes, call 911 or go to the nearest emergency room.