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Health condition

Infections of the spine, from spondylodiscitis to epidural abscess.

Uncommon but serious - spinal infection can hide behind ordinary back pain. Prompt MRI, targeted antibiotics and a spinal MDT are what change outcomes.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against BSAC, IDSA, BOA and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice for spondylodiscitis, spinal epidural abscess and implant-related infection.

Key facts

Spinal infection at a glance.

The essentials, in plain English - what it is, the main forms, how it starts and what modern UK treatment looks like.

  • What it is

    A group of infections of the vertebrae, disc, epidural space, subdural space, facet joints or implants - collectively called spinal infection.

  • Main forms

    Vertebral osteomyelitis and discitis (spondylodiscitis), spinal epidural abscess, subdural empyema, facet septic arthritis and post-surgical infection.

  • How it starts

    Usually haematogenous spread from another site - skin, urinary, endocarditis, injecting drug use - or direct extension after surgery or injection.

  • Who is at risk

    Diabetes, immunosuppression, dialysis, injecting drug use, recent spinal surgery and endocarditis all raise the risk.

  • The emergency

    Spinal epidural abscess with fever, severe back pain and progressive neurology is a surgical emergency - urgent MRI is essential.

  • Treatment

    Prolonged targeted antibiotics (typically 6 to 12 weeks) with surgery reserved for abscess, neurology or failed medical therapy - a specialist commissioned pathway.

Why this guide matters

The infection that hides behind back pain.

Spinal infection is uncommon but often missed - and the price of delay is high. The three points below shape everything else on this page.

  • Back pain plus fever is a red flag

    Nearly all spinal infection begins with unremitting back pain - fever is variable, but its presence must never be ignored.

  • MRI with contrast is the test

    Plain films and bloods are unreliable early on. Gadolinium-enhanced MRI - see our private MRI scan guide - is the gold standard for diagnosis.

  • Antibiotics for weeks, not days

    Directed antibiotics for 6 to 12 weeks, and 12 months for tuberculosis, deliver cure - stopping early risks relapse and destruction.

How the diagnosis is made

From first symptom to a targeted plan.

The steps a UK spinal team will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and risk factors

    Back pain pattern, fever, weight loss, immunosuppression, IV drug use, recent bacteraemia, dialysis or spinal procedure.

  2. 02

    Assessing

    Neurological examination

    A structured motor, sensory, reflex and sphincter exam - looking for cord compression, radiculopathy or cauda equina features.

  3. 03

    Assessing

    Red-flag triage

    Fever with severe back pain and any progressive weakness is treated as a spinal epidural abscess until proven otherwise.

  4. 04

    Confirming

    Inflammatory bloods and cultures

    CRP, ESR, full blood count and paired blood cultures taken before antibiotics wherever possible - a specialist commissioned step.

  5. 05

    Confirming

    MRI spine with gadolinium

    The gold-standard imaging test - see our guide to the private MRI scan - looking for disc, endplate, epidural and paraspinal changes.

  6. 06

    Confirming

    CT-guided biopsy

    Image-guided disc or vertebral biopsy for histology and microbiology when blood cultures are negative - a specialist commissioned pathway.

  7. 07

    Planning

    MDT and source hunt

    Spinal surgery, infectious diseases and microbiology review together, with echocardiography to look for endocarditis when appropriate.

Typical timeline: from presentation to a settled treatment plan within days, faster for a suspected epidural abscess.

Symptoms

What spinal infection actually feels like.

Back pain almost always leads, but the mix of fever, neurology and systemic upset is what tells you this is not simple mechanical pain - see our guide to herniated disc for comparison.

  • Persistent back pain

    Present in over 90 percent - typically deep, unremitting and often worse at night, not eased by rest.

  • Fever and systemic upset

    Fevers, rigors, sweats, malaise and weight loss - though fever is absent in up to half of spondylodiscitis cases.

  • Local spinal tenderness

    Focal percussion tenderness over the affected level and paraspinal spasm - a useful bedside clue.

  • Radicular pain

    Sharp, dermatomal pain radiating into a limb - suggests nerve-root involvement from disc, epidural collection or facet infection.

  • Weakness and gait change

    Progressive limb weakness, foot drop or difficulty walking - a warning sign of cord or root compression.

  • Sensory disturbance

    Numbness, tingling or a sensory level - the distribution helps localise the affected spinal segment.

  • Bladder or bowel change

    Retention, incontinence or saddle numbness - features of cauda equina that need same-day imaging and specialist review.

  • Red flag - fever plus neurology

    Fever with severe back pain and any progressive weakness is a spinal epidural abscess until proven otherwise - urgent MRI needed.

Treatment

How spinal infection is treated in the UK.

Prolonged targeted antibiotics under BSAC and IDSA guidance, with surgery reserved for abscess, neurology, instability or failed medical therapy - always through a specialist commissioned MDT.

  • Empirical antibiotics

    Broad-spectrum intravenous cover once cultures are taken - guided by microbiology, targeting Staphylococcus aureus including MRSA where relevant.

  • Directed antibiotics

    Narrowed to the causative organism once cultures return - typically 6 to 12 weeks total, with switch from IV to oral guided by response.

  • Anti-tuberculous therapy

    For spinal tuberculosis (Pott disease) - rifampicin, isoniazid, pyrazinamide and ethambutol for around 12 months under specialist commissioned care.

  • Surgical drainage

    For spinal epidural abscess with neurology, large collections or failed medical therapy - decompression and washout via a specialist commissioned spinal pathway.

  • Debridement and instrumentation

    For destructive spondylodiscitis with instability, deformity or persistent sepsis - debridement with grafting and fixation as needed.

  • Implant management

    Infected instrumentation may need removal, staged revision or suppressive antibiotics - decided within a specialist commissioned spinal MDT.

  • Bracing and physiotherapy

    External bracing for pain and stability during healing, followed by graded rehabilitation - always specialist supervised.

  • Treat the underlying source

    Endocarditis, injecting drug use, urinary sepsis and dental foci all need addressing to prevent relapse.

Not sure where to start?

If you are worried about back pain with fever, weight loss or new neurology, ask your GP or call NHS 111 for a prompt specialist spinal or infectious diseases opinion.

What this guide is based on

The sources behind every claim on this page.

UK and international specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or specialist knows your history and can tell you which parts apply to you. If in doubt - especially with fever, weakness or bladder change - get seen without delay.

  • BSAC. Joint guidelines on the diagnosis and management of native vertebral osteomyelitis in adults.

  • IDSA. Clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults.

  • British Orthopaedic Association (BOA). Standards for the management of spinal infection.

  • NICE Clinical Knowledge Summaries. Back pain - low back with red flags.

  • Public Health England. Guidance on the treatment of tuberculosis including spinal disease.

Red flags

When back pain needs urgent attention.

Most back pain is mechanical. These are the situations where it is not - and where the spinal team needs to be involved without delay.

  • Spinal epidural abscess

    Fever with severe back pain and any new or worsening weakness, sensory loss or sphincter change - a surgical emergency needing same-day MRI.

  • Cauda equina features

    Saddle anaesthesia, urinary retention, faecal incontinence or bilateral leg weakness - see our guide to cauda equina syndrome and seek emergency review.

  • Progressive cord compression

    Rising weakness, sensory level or brisk reflexes suggest cord involvement - imaging must not be delayed.

  • Sepsis

    High or low temperature, tachycardia, hypotension or confusion in a patient with back pain - treat as sepsis while imaging is arranged.

  • Recent spinal surgery or injection

    New severe pain, fever, wound discharge or dehiscence after a spinal procedure - urgent surgical review for implant or wound infection.

  • Endocarditis features

    New murmur, embolic phenomena or persistent bacteraemia point to endocarditis as the source - see our guide to endocarditis.

  • Immunosuppression

    Diabetes, dialysis, chemotherapy or HIV lower the threshold for admission and early imaging.

  • Suspected tuberculosis

    Insidious pain, weight loss, night sweats and risk-factor exposure - see our guide to tuberculosis and consider spinal TB.

  • Failure to improve on antibiotics

    Persistent pain, fever or rising inflammatory markers after two weeks of treatment - reimage and revisit surgery.

Living with it

A treatable illness, with a long recovery.

Four things make the biggest difference through the months of treatment - adherence, gradual rehab, close monitoring and treating the underlying source.

A quiet reminder

Recovery is measured in months, not weeks.

Pain often outlasts the infection. Steady, supervised rehabilitation restores strength and confidence - and reduces the risk of a second episode.

  1. 01 Adherence

    Finish the full course

    Prolonged antibiotics work only if taken to completion - typically 6 to 12 weeks, with regular clinical and blood-test review.

  2. 02 Rehab

    Rebuild strength gradually

    Bracing early, then graded physiotherapy - see our guide to spinal physiotherapy - to restore movement and stability.

  3. 03 Monitor

    Watch for warning signs

    Rising pain, fever, new weakness or bladder change means urgent review - relapse and abscess can develop weeks after discharge.

  4. 04 Prevent

    Treat the source

    Dental care, glycaemic control, dialysis-line hygiene and support for injecting drug use all reduce the risk of another episode.

Frequently asked

Everything we get asked about spinal infection.

Quick answers on spondylodiscitis, epidural abscess, tuberculosis of the spine and post-surgical infection.

  • What is spinal infection?

    It is a group of infections affecting the vertebrae, intervertebral disc, epidural or subdural space, facet joints or implanted spinal hardware. The commonest form is vertebral osteomyelitis with discitis - together called spondylodiscitis. Spinal epidural abscess is the most urgent, because it can compress the spinal cord.

  • How does the infection reach the spine?

    Most cases spread through the bloodstream from another site such as a skin, urinary or heart-valve infection - see our guide to endocarditis. Others follow direct extension from a nearby psoas or retroperitoneal collection, or occur after spinal surgery, injection or epidural procedure.

  • Which organisms cause it?

    Staphylococcus aureus (both MSSA and MRSA) is the leading cause. Gram-negative bacteria such as E. coli and Pseudomonas, streptococci and Enterobacter species also feature. Tuberculosis - see our guide to tuberculosis - brucella, salmonella and fungi such as Candida and Aspergillus are less common but important in specific groups, and are managed on a specialist commissioned pathway.

  • What is a spinal epidural abscess?

    A collection of pus in the space around the spinal cord. Classic features are fever, severe back pain and progressive weakness or sensory change. It is a surgical emergency - urgent MRI with gadolinium and specialist commissioned emergency review are essential, because delay risks permanent cord damage or cauda equina syndrome.

  • How is it diagnosed?

    Diagnosis combines history, examination, inflammatory bloods, blood cultures and MRI of the spine with gadolinium - the gold-standard test. Where possible a CT-guided biopsy of disc or vertebral bone is taken for microbiology and histology, and an echocardiogram looks for endocarditis when bloodstream infection is suspected.

  • How is it treated?

    Directed antibiotics for 6 to 12 weeks, guided by culture results, are the mainstay. Tuberculous spinal infection needs 12 months of RIPE therapy. Surgery is reserved for epidural abscess, progressive neurology, instability, deformity or failed medical treatment. Infected implants often need staged revision. The whole plan is delivered through a specialist commissioned MDT of spinal surgery, infectious diseases and microbiology.

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