Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Spinal compression, instability or sepsis
New weakness, sensory loss, sphincter dysfunction, saddle symptoms, spinal deformity, shock or uncontrolled deep abscess can indicate cord or cauda equina compromise and invasive sepsis.
Action: Use ABCDE, perform and document urgent neurological examination, obtain blood cultures, start intravenous therapy if unstable and arrange emergency spinal MRI and same-day spinal surgical and infection-specialist review.
Synopsis
Recognise bone and spinal infection, obtain blood and deep microbiology before treatment when safe, use MRI appropriately and secure drainage, stabilisation or decompression for complications.
Osteomyelitis is infection of bone; discitis and vertebral osteomyelitis commonly overlap across the disc and adjacent vertebral endplates.
Blood cultures are essential before antibiotics in suspected haematogenous or vertebral disease and may establish the organism without biopsy.
MRI with appropriate contrast is the preferred imaging test for vertebral infection, marrow involvement, epidural abscess and neural compression.
Key red flags
New limb weakness, sensory level, saddle sensory change or bladder and bowel dysfunction requires emergency spinal imaging.
Vertebral infection pattern
Constant focal spinal pain, night pain, painful movement and paraspinal spasm with inflammatory or bloodstream risk supports discitis or vertebral osteomyelitis.
Investigation priorities
01
Blood culturesFirst step
Identify haematogenous organisms before antimicrobial exposure and guide the need for biopsy.
Management branches
NEUROLOGICALProtect cord and cauda equina
Spinal infection is possible and a neurological deficit, sphincter symptom, deformity or instability is present.
Use ABCDE, document motor power, sensation, reflexes, gait if safe, perianal sensation and bladder findings and repeat after any change.
Obtain blood cultures and urgent whole-region MRI with sequences adequate to detect epidural abscess and compression.
STABLESecure microbiology before prolonged therapy
Bone or disc infection is likely but the patient has no sepsis, neurological compromise or rapidly destructive progression.
Key medicines
Empirical osteomyelitis intravenous regimenGive the exact local site-, exposure-, allergy-, renal- and resistance-adjusted intravenous regimen after blood and deep cultures when the patient is stable enough for sampling.
Flucloxacillin for susceptible staphylococciGive 2 g intravenously every four to six hours when directed for methicillin-susceptible Staphylococcus aureus, using the exact local severe bone-infection interval.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.