Guidelines: Consider Vertebral Osteomyelitis in Patients With Continuous Back Pain

Since vertebral osteomyelitis is fairly rare, - every year, two to six out of 100,000 people are diagnosed - it is an often overlooked illness.

New guidelines on vertebral osteomyelitis urge physicians who have patients with back pain that does not go away, despite continued therapy, to consider this diagnosis. 

Released by the Infectious Diseases Society of America and published in the journal of Clinical Infectious Diseases, the guidelines note that since vertebral osteomyelitis is fairly rare,  – every year, two to six out of 100,000 people are diagnosed – it is an often overlooked illness. 

“Back pain is so common – and usually not caused by infection – that diagnosis often is missed or delayed,” said Elie F. Berbari, MD, lead author of the guidelines and associate chair of education for the division of infectious disease at Mayo Clinic College of Medicine, Rochester, Minn said in a press release about the guildeines. “The infection causes severe pain that often wakes the person at night and does not go away after pain management or rest. If that’s the case, the doctor needs to start considering that something else is going on, especially if the patient has a fever.”

Simple blood tests to check for inflammation (including sedimentation rate and C-reactive protein) can help determine if vertebral osteomyelitis may be causing the pain, the guidelines note. 

If those tests are positive, the guidelines recommend the patient have a magnetic resonance imaging (MRI) test, which can differentiate between an infection and a common back problem, such as a slipped disc. If vertebral osteomyelitis is suspected after the MRI, the patient should have a biopsy to confirm infection and determine the bacteria responsible, according to the panel. 

Treatment typically involves six weeks of intravenous (IV) antibiotics. In about half of patients, surgery to remove the infection may be necessary, Berbari said.

If the patient’s pain improves after antibiotics or surgery, a repeat MRI usually is not necessary, the guidelines say.

The voluntary guidelines are not intended to take the place of a doctor’s judgment, but rather to support the decision-making process, which must be individualized according to each patient’s circumstances, according to the guideline authors.

The 11-member vertebral osteomyelitis guidelines panel comprises experts representing a variety of specialties.


1. Berberi EF, et al. Clin Infect Dis. 2015 doi:10.1093/cid/civ482