Discitis - A rare spinal infection that needs prompt medical assessment
Why Discitis causes severe, persistent back pain and should not be ignored
Discitis is an infection affecting the spinal disc, sometimes involving the nearby vertebrae as well. It is uncommon, but when it occurs it can cause severe, persistent back pain, significant stiffness, and systemic symptoms such as fever or feeling generally unwell.
Unlike most causes of back pain, discitis is not mechanical and does not improve with rest or simple pain relief. Because it involves infection, early recognition and treatment are important to prevent complications and long-term damage.
This page explains what discitis is, how it presents, how it is diagnosed, and when urgent medical assessment is required.
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What Is Discitis?
Discitis is an infection involving the intervertebral disc, the soft structure that sits between the bones (vertebrae) of the spine and helps absorb load and allow movement.
In adults, discitis almost never occurs in isolation. Adult intervertebral discs have a very limited direct blood supply, which means infection usually reaches the disc by spreading from nearby bone. As a result, discitis in adults is commonly associated with infection of the adjacent vertebrae — a combined condition often referred to as discitis–osteomyelitis.
Discitis is rare, but it is considered a serious medical condition. If it is not recognised and treated promptly, the infection can lead to progressive pain, spinal instability, nerve irritation, and in severe cases systemic illness.
How Does Discitis Develop?
Discitis most commonly develops when bacteria enter the bloodstream and travel to the spine. This process is known as haematogenous spread.
The bacteria may originate from:
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skin infections
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urinary tract infections
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chest infections
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dental infections
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infected intravenous lines or catheters
In some cases, discitis can occur after:
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spinal surgery
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spinal injections
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other invasive procedures
However, in a significant number of people, no clear source of infection is ever identified.
Once bacteria reach the spinal structures, they can lodge in the vertebral bone and spread into the adjacent disc. Because the disc itself has limited immune surveillance, infection can progress silently at first, before symptoms become obvious.
Who Is At Higher Risk Of Discitis?
Discitis can occur in anyone, but certain factors increase risk, including:
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increasing age
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diabetes
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reduced immune function (for example due to steroid use, chemotherapy, or autoimmune disease)
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intravenous drug use
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recent infection elsewhere in the body
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recent spinal surgery or injections
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chronic kidney disease
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poor general health or frailty
Importantly, discitis can still occur in people without obvious risk factors, which is one reason it can be missed.
What Symptoms Does Discitis Cause?
The most common symptom of discitis is severe, persistent spinal pain.
Typical features include:
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pain that is constant and progressive
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pain that is poorly relieved by rest or position change
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pain that may be worse at night
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pain that feels deeper and more intense than mechanical back pain
Other possible symptoms include:
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stiffness and reduced movement
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muscle spasm around the spine
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pain radiating into the chest, abdomen, or limbs (depending on spinal level)
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general fatigue or malaise
Systemic symptoms such as fever may occur, but are often absent, especially in older adults. This absence of fever is one of the reasons discitis is frequently misdiagnosed early on.
Why Discitis Is Often Missed Early On
Discitis is commonly misdiagnosed in its early stages, sometimes for weeks or even months.
Reasons include:
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it is rare, so clinicians encounter it infrequently
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early symptoms can resemble common back or neck pain
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fever and blood test abnormalities may be absent initially
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pain may be attributed to “wear and tear”, disc problems, or muscle strain
Because mechanical back pain is so common, a serious but rare condition like discitis may not be considered until symptoms fail to improve or worsen significantly.
This delay in diagnosis can allow the infection to progress, increasing the risk of complications.
How Is Discitis Diagnosed?
Diagnosis of discitis requires a combination of clinical suspicion, blood tests, and imaging.
Key components include:
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blood tests looking for markers of inflammation and infection
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blood cultures to try to identify the responsible organism
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MRI scanning, which is the imaging test of choice
MRI is particularly important because:
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early X-rays are often normal
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MRI can detect infection before structural damage is obvious
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it helps distinguish discitis from other causes of spinal pain
In some cases, a biopsy or aspiration may be required to identify the causative organism if blood cultures are negative.
How Is Discitis Treated?
Discitis requires medical treatment, usually under specialist care.
Treatment typically involves:
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prolonged courses of antibiotics, often given intravenously at first
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close monitoring of symptoms and blood markers
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pain management
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temporary activity modification or spinal support
Treatment duration is often several weeks to months, depending on severity, response to treatment, and the organism involved.
Surgery is not commonly required, but may be necessary in cases where:
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there is spinal instability
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abscess formation occurs
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neurological compromise develops
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infection does not respond to antibiotics
What Is The Recovery Like?
Recovery from discitis can be slow, even with appropriate treatment.
Many people experience:
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gradual improvement in pain over weeks to months
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ongoing stiffness or reduced tolerance to activity initially
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fatigue during recovery
With timely diagnosis and appropriate treatment, long-term outcomes are often good, but some people may be left with residual stiffness, reduced spinal movement, or altered load tolerance.
Rehabilitation may involve:
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gradual return to movement and activity
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reassurance and education
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carefully progressed strengthening and conditioning
When Should You Seek Urgent Medical Advice?
Urgent medical assessment is required if someone develops:
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severe, persistent spinal pain that is worsening
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back or neck pain associated with fever, chills, or unexplained illness
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pain following recent infection, surgery, or invasive procedures
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new neurological symptoms (weakness, numbness, bowel or bladder changes)
Discitis is not something to “wait and see” if symptoms are concerning or progressive.
The Key Message
Discitis is a rare but serious spinal infection that is often missed early because it mimics common back pain.
Persistent, severe, non-mechanical spinal pain — especially when it does not improve as expected — should always prompt consideration of non-mechanical causes, including infection.
Early diagnosis and appropriate medical treatment are critical. While recovery can take time, timely recognition significantly improves outcomes.
Frequently Asked Questions about Discitis
1) What is discitis?
Discitis is an infection of the spinal disc, often involving the nearby vertebrae as well. It is uncommon but serious, and it requires medical treatment rather than physical or mechanical management.
2) How common is discitis?
Discitis is rare, especially compared to common causes of back pain such as muscle strain or disc degeneration. Most people with back pain will never develop discitis, but it is an important diagnosis not to miss.
3) What does discitis pain feel like?
Pain from discitis is usually:
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severe and constant
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present at rest and often worse at night
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not relieved by changing position
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associated with marked stiffness and reluctance to move
This type of pain behaves very differently from mechanical back pain.
4) Does discitis cause fever or illness?
Sometimes, but not always. Some people develop fever, chills, sweats, or feel generally unwell, while others may have severe back pain without obvious systemic symptoms, which can delay diagnosis.
5) What causes discitis?
Discitis is usually caused by bacteria entering the bloodstream and settling in the spinal disc. This may occur after an infection elsewhere in the body, surgery, injections, or invasive procedures. In some cases, no clear source is identified.
6) Who is most at risk of discitis?
Risk is higher in people with:
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a weakened immune system
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diabetes
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cancer or chemotherapy
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long-term steroid use
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chronic kidney disease
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recent spinal surgery or procedures
However, discitis can still occur in people without obvious risk factors.
7) How is discitis diagnosed?
Discitis is usually diagnosed using:
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blood tests to look for infection and inflammation
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MRI scanning, which is the most sensitive imaging test
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blood cultures to identify the infecting organism
Early X-rays are often normal and cannot rule discitis out.
8) Can physiotherapy treat discitis?
No. Discitis is an infection, not a mechanical problem, and it cannot be treated with physiotherapy alone. Physiotherapy is usually introduced after the infection is controlled, to help restore movement and strength during recovery.
9) How is discitis treated?
Treatment typically involves:
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prolonged courses of antibiotics (often initially given intravenously)
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pain management
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careful medical monitoring
Hospital admission is common, particularly early in treatment.
10) When should I seek urgent medical advice?
You should seek urgent assessment if you have:
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severe, persistent back pain that does not improve with rest
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back pain with fever, chills, or night sweats
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back pain with feeling generally unwell
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worsening pain following recent infection, surgery, or spinal procedure
Discitis is rare, but early diagnosis makes a significant difference.
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