When Back Pain Could Indicate a Serious Infection

You’re awoken by sudden and excruciating back pain. No matter what position you try, there is no relief. And it’s not just back pain you’re dealing with. You also don’t feel well. You may have an unexplained fever, swelling or tenderness of the spine, abdominal pain or even a rapid heart rate. 

You could be suffering from a serious infection in your back called lumbar discitis.

Low back pain is the leading cause of disability worldwide, according to the World Health Organization. While most back pain will get better on its own or with conservative treatment, some conditions, like lumbar discitis, can, if left undiagnosed or untreated, lead to serious and permanent disability or even death.

“There are few problems that keep me up at night more than lumbar discitis,” admitts Ronald Tolchin, D.O., physical medicine and rehabilitation medical director at Baptist Health Miami Neuroscience Institute and the Kalman Bass Endowed Chair in Pain and Rehabilitative Medicine. “The prognosis is favorable if caught early, but there is no time to spare in these cases.” 

What is Lumbar Discitis?

An infection within the soft discs that are located between the vertebrae of the spine, lumbar discitis is not common but can progress rapidly over a period of days or weeks and result in neurological deficits that include weakness, numbness or bladder/bowel dysfunction. 

Dr. Tolchin spoke about lumbar discitis recently at the 2025 Baptist Health Spine Symposium, where some 300 physicians and other healthcare professionals heard from Institute experts about the latest treatments for degenerative diseases of the spine.

Lumbar discitis occurs most often in adults ages 50 to 70. There are a number of predisposing risk factors, including:

• Recent spine surgery or intervention
• Other surgical procedures
• A systemic infection such as a urinary tract infection, endocarditis or a skin infection
• Immunosuppression issues caused by diabetes, cancer, HIV or steroid use
• IV drug use

“When a patient comes in with back pain, whether it’s to a spine specialist, a surgeon, an emergency room or a primary care office, I tell doctors not to assume the patient is experiencing mechanical back pain,” Dr. Tolchin says. “These are patients with severe pain in every position. Ultimately, they get very sick. Ask the right questions. Listen to the patients and they will generally guide you in the right direction.”

What Are the Causes and Treatments for Lumbar Discitis?

The most common cause of infection in lumbar discitis is bacteria such as Staphylococcus aureus, Escherichia coli or Pseudomonas aeruginosa. In addition to your physical exam, doctors may order an MRI, X-ray, CT-guided biopsy, or a combination of imaging studies, as well as blood work that includes inflammatory markers and blood cultures.

Ronald Tolchin, D.O., physical medicine and rehabilitation medical director at Baptist Health Miami Neuroscience Institute and the Kalman Bass Endowed Chair in Pain and Rehabilitative Medicine

Non-surgical treatments include antibiotics, pain management and bracing to support the spine. But lumbar discitis patients should not take steroids, warns Dr. Tolchin. Surgery may be necessary if the condition doesn’t respond to antibiotics, if an abscess has formed or if the spine has become structurally unstable due to disc destruction. Most post-surgical patients require antibiotics for six to 12 weeks, physical therapy or rehabilitation to improve mobility and strength and regular monitoring to assess the resolution of infection and stability of the spine.

If you have an ongoing back problem, Dr. Tolchin recommends seeing a physician at Miami Neuroscience Institute. There are numerous locations throughout South Florida. Find a doctor here.