A patient presents with sudden and excruciating back pain. No matter their position, there is no relief. They generally don’t feel well and may have an unexplained fever, swelling or tenderness of the spine, abdominal pain or even a rapid heart rate.
“There’s no time to spare in these cases,” said 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. Your patient could be suffering from lumbar discitis.
An infection within the soft discs 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.
“There are few problems that keep me up at night more than lumbar discitis,” said Dr. Tolchin, who spoke 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.
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.
To accurately diagnose a patient with discitis, Dr. Tolchin stressed having an open mind when walking into the exam room. “These are patients with severe pain in every position. They don’t feel well. Don’t put patients in a box and automatically assume they are experiencing mechanical back pain,” he said. “Ask the right questions. Listen to the patient and they will generally guide you in the right direction.”
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
Patients with these risk factors should be screened more closely. Also consider lumbar discitis in high-risk patients with unexplained symptoms, including lower back pain with systemic symptoms, persistent symptoms after spinal intervention or prolonged bacteremia without a clear source.
The most common cause of infection in lumbar discitis is bacteria such as Staphylococcus aureus, Escherichia coli or Pseudomonas aeruginosa. Complications can occur when the infection spreads to vertebral bodies, creates an epidural abscess or causes spinal instability or deformity.
In addition to the physical exam, consider ordering an MRI (the gold standard), X-ray (limited for early detection but can show late-stage bone destruction or disc space narrowing or collapse), CT-guided biopsy (for microbiological confirmation if blood cultures are negative), or a combination of imaging studies, as well as blood work that includes inflammatory markers and blood cultures.
Non-surgical treatments include antibiotics, pain management and bracing to support the spine. But lumbar discitis patients should not take steroids, warned 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.
Miami Neuroscience Institute has numerous locations throughout South Florida.
