Mir H. Ali, MD, PhD
Orthopedic Spine Surgery
Patient Educational Series
Spine Infections - Part I: Osteomyelitis and Discitis
Spine infections can be considered a serious and life-threatening problem. These can vary from mild pain-
causing infections to completely paralytic infections that may even cause death. Most commonly a spine
infection is acquired through the bloodstream and is present with an infection somewhere else in the patient's
body. Rarely an infection can be due to procedures such as injections or surgery. In these cases, the
infection is limited largely to the spine itself. As soon as the thought of a spine infection is entertained,
an infectious disease specialist as well as a spine surgeon should be involved and consulted.
The most common spine infection is known as vertebral osteomyelitis, which basically means that the infection
in the spine is limited to the bones themselves. It does not involve the spinal canal, the spinal nerves, or
the discs. This is usually acquired from the bloodstream through a process called hematogenous seeding in a
large majority of cases. This is so often the case that whenever I see a patient with vertebral osteomyelitis
my first thought is to look for infection elsewhere in the body.
The most common symptom of a spine infection is isolated back pain. The most classical complaint is that the
patient cannot find relief from his/her back pain in any position. Most people who have back pain from a
fracture or from a herniated disc can find comfort while laying down. However, in the case of a patient with
a spine infection, he/she seems to never be able to get a comfortable position no matter how hard he/she seems
to try. One should consider the possible diagnosis of a spine infection - however rare it might be - whenever
thinking about the cause of a patient's back pain. If if the possibility exists of a spine infection, more
testing maybe required, usually in the form of an MRI and blood tests. The MRI provides the most specific
information regarding the nature of the infection and the location of the infection. It is very important
to diagnose and treat a spine infection as early as possible to prevent its progression and to prevent any
possible damage to the spinal nerves / spinal cord.
While vertebral osteomyelitis can be a severe and painful condition, surgical treatment can be largely
avoided with early treatment with intravenous antibiotics and occasional bracing to make the patient
comfortable while the antibiotics help remove the infection. I only consider surgery if the infection
spreads and begins to compress the nerves and/or the patient fails a prolonged course of non-operative
treatment (>3 months).
Given the fact that the vertebra are next to the discs in the spine, very commonly the infection in the
vertebra can spread or also involve the adjacent discs. This condition is known as discitis and collectively
this condition is known as osteomyelitis/osteodiscitis. Usually discitis present sin a very similar way to
osteomyelitis in that the patient's main complaint is usually isolated low back pain without the ability
to find a comfortable position. Discitis is also most often caused by the process of hematogenous seeding.
The ability to detect changes in the disc on xrays may be limited and thus an MRI is again used with blood
tests to confirm the diagnosis of discitis. Very similar to osteomyelitis, discitis rarely require surgerys
and can be usually treated with a course of intravenous antibiotics and bracing for comfort. The treatment
course for these infections can be complicated and must thus be managed in a team oriented approach by an
infectious disease specialist and an orthopedic spine surgeon.
Mir H. Ali, MD,PhD
Director - Deerpath Spine Institute
Orthopedic Spine Surgeon - Rezin Orthopedics & Sports Medicine
Dr. Ali is a board certified orthopedic spine surgeon trained in the diagnosis as well as the treatment of
non-operative and operative spinal disorders. Dr. Ali practices in the far western and southwestern
suburbs of Chicago and utilizes surgery as a last resort when all other non-operative treatments have
failed to relieve pain and/or reduce risk of nerve damage/injury. All recommendations on this site are for
general situations and a particular situation requires evaluation before specific treatment recommendations
can be made.