• Infection in the intervertebral disc space
    • occurs post surgically in approximately 1-2% of patients after spinal surgery.
  • Infection of nucleus pulposus due to infection of vertebral body end-plate cartilage
  • Risk Factors: pediatric patients (age < 8yo), post-op, immunocompromised

Clinical Features

  • >90% present with unremitting neck or back pain which awakens them at night
    • May have radicular symptoms
  • Fever (60-70%)
  • Neuro deficits (10-50%)
  • ESR elevation (>90%)
  • Leukocytosis (<50%)

Differential Diagnosis

CT of an infected disc at the level of C5-C6 causing neurological symptoms
MRI of discitis in a 2 year old child.

Spinal infection

Lower Back Pain


  • Labs
    • ESR elevated
  • Imaging
    • Plain films are rarely positive
    • MRI is gold standard


IV Antibiotics

Inpatient Therapy

Use cefepime or ciprofloxacin if targeting Pseudomonas spp


  • Admit