{"id":8112,"date":"2026-04-24T12:00:58","date_gmt":"2026-04-24T10:00:58","guid":{"rendered":"https:\/\/complexspineinstitute.com\/sin-categoria\/back-pain-with-fever-9-signs-spinal-infection-not-lumbago\/"},"modified":"2026-04-24T12:00:24","modified_gmt":"2026-04-24T10:00:24","slug":"back-pain-with-fever-9-signs-spinal-infection-not-lumbago","status":"publish","type":"post","link":"https:\/\/complexspineinstitute.com\/en\/neurosurgery-blog\/back-pain-with-fever-9-signs-spinal-infection-not-lumbago\/","title":{"rendered":"Back pain with fever: 9 signs it may be a spinal infection and not simple low back pain"},"content":{"rendered":"\t\t
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Back pain is very common and most of the time is not due to a serious cause. But when it appears together with fever, chills, malaise, severe night pain or neurological symptoms, the level of attention should change. A spinal infection is uncommon, but it can be serious if diagnosis is delayed.<\/p>

A spinal infection can affect the vertebrae, the intervertebral disc, the epidural space or nearby tissues. Sometimes it is mistaken for common low back pain because the main symptom may be only persistent back pain. The key is to recognize warning signs, request appropriate tests and act quickly if there is fever, weakness, sphincter disturbance or overall deterioration.<\/p>

  • Back pain with fever is not always an emergency, but it should never be ignored if it is intense, progressive or different from the usual pain.<\/li>
  • Discitis (spondylodiscitis) and vertebral osteomyelitis are infections of the disc and vertebrae.<\/li>
  • Spinal epidural abscess can compress nerves or the spinal cord and requires urgent evaluation.<\/li>
  • Magnetic resonance imaging (MRI) is usually the key test when deep infection is suspected.<\/li>
  • Treatment may include targeted antibiotics and, in selected cases, surgery.<\/li>
  • Self-medicating with antibiotics or corticosteroids can hinder diagnosis.<\/li><\/ul>

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    What is a spinal infection<\/h2>

    The spine is not just a row of bones. It includes vertebrae, discs, joints, ligaments, muscles, nerve roots and the spinal cord. An infection can appear in several areas. When it affects the vertebral bone it is called vertebral osteomyelitis. When it affects the disc and adjacent vertebrae the term spondylodiscitis is used. When a collection of pus forms near the spinal cord or nerve roots it is called a spinal epidural abscess.<\/p>

    These infections can occur because a bacterium travels through the bloodstream from another area of the body, for example a urinary, dental, skin infection or bacteremia. They can also appear after invasive procedures, injections, surgeries or in people with weakened immunity. Still, in some patients a clear portal of entry is not identified.<\/p>

    The important thing is to understand that they do not behave like a muscle strain. Mechanical low back pain usually fluctuates with posture, effort and rest. An infection can cause deep, persistent, progressive pain, sometimes worse at night, and be accompanied by fever, chills, severe fatigue or loss of appetite.<\/p>

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    9 signs not to overlook<\/h2>
    1. New, intense back or neck pain accompanied by fever.<\/li>
    2. Pain that worsens day by day and does not behave like usual low back pain.<\/li>
    3. Night pain that wakes you or prevents sleep for several consecutive nights.<\/li>
    4. Chills, sweating, malaise or a feeling of systemic illness.<\/li>
    5. Weakness, clumsiness when walking, progressive loss of sensation or tingling.<\/li>
    6. Difficulty urinating, incontinence or loss of sensation in the genital or perineal area.<\/li>
    7. Recent history of bloodstream infection, urinary, dental, skin infection or endocarditis.<\/li>
    8. Recent surgery, injection, catheter, hemodialysis or other invasive procedure.<\/li>
    9. Diabetes, immunosuppression, chronic corticosteroid treatment, cancer or advanced age with persistent pain.<\/li><\/ol>

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      Symptoms and indications<\/h2>

      How it may start<\/h3>

      At the beginning, a spinal infection can be deceptive. Some people only notice persistent lumbar or cervical pain. Fever may not be present from day one, or it may be intermittent. That’s why context matters: a pain after lifting a heavy object is not interpreted the same as new pain in a person with recent bacteremia, poorly controlled diabetes or a surgical wound that is draining.<\/p>

      When it affects nerves or the spinal cord<\/h3>

      If the infection inflames tissues near the nerve roots, radiating pain to a leg or arm may appear. If there is compression of the spinal cord or the roots of the cauda equina, loss of strength, gait disturbance, clumsiness, saddle numbness or bladder and bowel problems may occur. These signs change the priority: it is no longer appropriate to observe for several days, but to evaluate urgently.<\/p>

      After spinal surgery<\/h3>

      After an operation it is normal to have pain, fatigue and wound discomfort. What is concerning is different: persistent fever, chills, pain that increases instead of improving, a wound that is red, warm, with purulent discharge or bad odor, or the appearance of neurological deficit. In that context, it is advisable to consult without waiting for the next scheduled check-up.<\/p>

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      Diagnosis<\/h2>

      Medical history and physical examination<\/h3>

      Diagnosis begins with specific questions: when did the pain start, is there fever, is there a recent infection, was there surgery or injections, is there diabetes or immunosuppression, and have neurological symptoms appeared. The examination checks strength, sensation, reflexes, gait, localized pain and general signs of infection.<\/p>

      Blood tests<\/h3>

      Blood tests can show inflammation through C-reactive protein and erythrocyte sedimentation rate. Blood cultures may also be requested to try to identify the responsible bacterium. This is important because the ideal treatment is not \u201cany antibiotic\u201d, but one targeted to the probable or confirmed microorganism.<\/p>

      Magnetic resonance imaging<\/h3>

      MRI is usually the most useful imaging test when deep spinal infection is suspected. It allows assessment of discs, vertebrae, the epidural space, soft tissues and possible neurological compression. In some cases CT, PET-CT or other tests are used, especially if MRI is not possible or if there are diagnostic doubts.<\/p>

      Biopsy or image-guided sampling<\/h3>

      If blood cultures do not identify the germ and the situation allows, an image-guided biopsy may be considered. The aim is to obtain a sample of the disc, vertebra or affected tissue for culture and analysis. This helps tailor antibiotics and avoids unnecessary or poorly directed treatments.<\/p>

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      Non-surgical and surgical alternatives<\/h2>

      Non-surgical treatment<\/h3>

      Many vertebral infections are treated with antibiotics, pain control, laboratory follow-up and clinical monitoring. Duration is usually measured in weeks, not days. Sometimes treatment starts in the hospital and then continues on an outpatient basis, depending on severity, the organism, the response and the general condition.<\/p>

      Temporary adjustment of mobility may also be necessary. This does not mean prolonged strict bed rest in all cases. Excessive immobilization can worsen strength, balance and the risk of complications. The plan should balance pain control, spinal stability and functional recovery.<\/p>

      When surgery may be needed<\/h3>

      Surgery is considered when there is neurological compression, progressive deficit, an abscess that requires drainage, spinal instability, deformity, intractable pain or failure of medical treatment. Surgery does not always replace antibiotics: in many cases it is part of a combined plan to decompress, remove infected tissue, stabilize and allow antimicrobial treatment to work better.<\/p>

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      Benefits, risks and adverse effects<\/h2>

      Expected benefits<\/h3>

      The main benefit of early detection of a spinal infection is reducing the risk of neurological damage, deformity, sepsis or chronic pain. When treatment is targeted to the correct organism and stability is controlled, many people improve progressively. Pain usually takes longer to resolve than a superficial infection because bone, disc and deep tissues recover slowly.<\/p>

      Treatment risks<\/h3>

      Antibiotics can cause adverse effects such as diarrhea, allergic reactions, liver or kidney abnormalities or interactions with other medications. Therefore they are monitored according to the drug and the patient. Surgery, if necessary, carries risks such as bleeding, persistent infection, neurological injury, cerebrospinal fluid leak, implant failure or need for further procedures. The specific risk depends on the location, extent of infection, age, comorbidities and initial neurological status.<\/p>

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      Criteria for referral<\/h2>

      Rapid referral to the emergency department or a specialized team is advisable when there is back pain with fever, marked elevation of inflammatory markers, positive blood cultures, neurological deficit, suspected epidural abscess, recent surgery with signs of infection or persistent pain in a person with important risk factors.<\/p>

      Referral is even more urgent if pain appears together with loss of strength, gait disturbance, confusion, low blood pressure, severe chills, rapid worsening or problems controlling urine and stool.<\/p>

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      Realistic recovery times<\/h2>

      Recovery is not usually immediate. In uncomplicated vertebral infections, pain may improve in days or weeks, but full recovery can take months. Tests help to see if inflammation decreases, but imaging may take longer to normalize. That is why MRI is not always repeated if the person improves clinically and markers evolve well.<\/p>

      If there was neurological deficit, abscess, surgery or instability, timelines are longer. Rehabilitation may be necessary to recover strength, gait and confidence. Returning to work or intense activities depends on pain, mobility, job type, spinal stability and response to treatment.<\/p>

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      When to go to the emergency department<\/h2>

      Seek urgent care if back or neck pain appears with high fever, chills or malaise, especially if the pain is intense or progressive. Also if there is new weakness, difficulty walking, loss of sensation, problems urinating or defecating, saddle anesthesia, confusion, low blood pressure or rapid worsening.<\/p>

      After spinal surgery, go to the emergency department if there is persistent fever, a wound with pus, progressive redness, pain that increases day by day, uncontrolled pain, shortness of breath, chest pain, loss of strength or sphincter problems.<\/p>

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      Myths and realities<\/h2>

      Myth: if I don’t have a high fever, it can’t be an infection<\/h3>

      Reality: fever may be absent or appear intermittently. In older people, immunosuppressed patients or those on certain treatments, the febrile response can be less evident.<\/p>

      Myth: an MRI that shows \u201cwear and tear\u201d always explains the pain<\/h3>

      Reality: many people have degenerative changes on MRI. If there is fever, high inflammation or malaise, one should not attribute everything to wear and tear without investigating.<\/p>

      Myth: a few days of oral antibiotics will fix it<\/h3>

      Reality: deep spinal infections usually require longer, targeted treatments. Taking antibiotics without a diagnosis can obscure cultures and delay correct treatment.<\/p>

      Myth: if there is an infection, surgery is always necessary<\/h3>

      Reality: not always. Many infections are treated without surgery. Operation is reserved for cases with compression, instability, abscess, neurological deterioration or poor response.<\/p>

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      Frequently asked questions<\/h2>

      Does back pain with fever always mean a spinal infection?<\/h3>

      No. It can be due to influenza, a urinary infection, respiratory problems or other causes. But if the pain is intense, localized, progressive, nocturnal or accompanied by neurological symptoms, a serious cause should be ruled out.<\/p>

      What is the difference between spondylodiscitis and vertebral osteomyelitis?<\/h3>

      Vertebral osteomyelitis affects the bone of the vertebra. Spondylodiscitis affects the disc and the adjacent vertebrae. In practice they can overlap and are studied similarly.<\/p>

      What is a spinal epidural abscess?<\/h3>

      It is a collection of pus in the epidural space, near the spinal cord or nerve roots. It can compress neurological structures and requires urgent evaluation.<\/p>

      Does an X-ray rule it out?<\/h3>

      A normal X-ray does not rule out an early infection. If suspicion is high, MRI usually provides much more information.<\/p>

      Can it be treated without surgery?<\/h3>

      Yes, in many cases. If there is no neurological deficit, instability or an abscess that requires drainage, treatment can be based on targeted antibiotics and close follow-up.<\/p>

      How long does treatment last?<\/h3>

      It depends on the organism, severity and evolution. Many vertebral infections require several weeks of treatment, with clinical and laboratory checks.<\/p>

      Can I take anti-inflammatories and wait?<\/h3>

      If there is fever, malaise, progressive pain or neurological symptoms, it is not advisable to limit care to masking the pain. It is better to consult to evaluate whether tests and imaging are needed.<\/p>

      When is it really urgent?<\/h3>

      It is urgent if there is loss of strength, problems with urine or stool, saddle numbness, high fever with intense pain, confusion, rapid deterioration or suspected sepsis.<\/p>

      \u00a0<\/p>

      Glossary<\/h2>
      • Spondylodiscitis: infection that affects the intervertebral disc and the adjacent vertebrae.<\/li>
      • Vertebral osteomyelitis: infection of the bone of a vertebra.<\/li>
      • Epidural abscess: collection of pus in the epidural space, near the spinal cord or nerve roots.<\/li>
      • Blood culture: blood sample culture to detect bacteria or other microorganisms.<\/li>
      • C-reactive protein: an inflammation marker that may be elevated in infections.<\/li>
      • Erythrocyte sedimentation rate: a test that indicates inflammation in the body.<\/li>
      • Neurological deficit: loss of strength, sensation, reflexes or control of nervous functions.<\/li>
      • Sepsis: a severe systemic response to infection that can compromise organs.<\/li><\/ul>

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        References<\/h2>
        1. IDSA Clinical Practice Guidelines for Native Vertebral Osteomyelitis in Adults, 2015.<\/li>
        2. AANS Spinal Infections, 2024.<\/li>
        3. SPILF Clinical Practice Guidelines for Disco-Vertebral Infection in Adults, 2023.<\/li>
        4. StatPearls: Vertebral Osteomyelitis, update 2024-2025.<\/li>
        5. StatPearls: Spinal Epidural Abscess, update 2025.<\/li>
        6. Current knowledge of vertebral osteomyelitis: a review, 2025.<\/li>
        7. Clinical review on spinal epidural abscess, 2024.<\/li>
        8. Red flags presented in current low back pain guidelines, European Spine Journal, 2016.<\/li>
        9. Low Back Pain: Evaluation and Management, StatPearls, update 2025.<\/li>
        10. Diagnosis and management of infections related to spinal pain and surgery, 2024.<\/li><\/ol>

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          Health education notice: this content is informative and does not replace an individual medical assessment. If you have fever with severe pain, loss of strength, sphincter disturbances, genital numbness or general malaise, seek urgent medical attention.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":8105,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[19],"tags":[],"class_list":["post-8112","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-neurosurgery-blog"],"_links":{"self":[{"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/posts\/8112","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/comments?post=8112"}],"version-history":[{"count":1,"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/posts\/8112\/revisions"}],"predecessor-version":[{"id":8116,"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/posts\/8112\/revisions\/8116"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/media\/8105"}],"wp:attachment":[{"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/media?parent=8112"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/categories?post=8112"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/complexspineinstitute.com\/en\/wp-json\/wp\/v2\/tags?post=8112"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}