The incidence of spinal infections is about 1 or 2 in 10,000 and may occur in the intervertebral discs, vertebrae, or dura mater. Patients with immune deficiencies, such as renal insufficiency, diabetes mellitus, cirrhosis of the liver, and even drug addiction or AIDS are at high risk for this disease. Patients with a history of back surgery or intravertebral anesthesia should also be aware of the possibility of spinal infection. In severe cases, patients may experience numbness or abnormal sensation in the extremities or lower extremities, or even weakness or paralysis in both lower extremities. Blood tests may reveal an increase in leukocytosis, C-reactive protein (CRP) and ESR. X-rays may not always reveal early inflammatory changes in the spine, and CT or MRI is usually required to visualize inflammation in the vertebrae, discs and spinal canal. If anti-infective medications are not effective or if there are symptoms of nerve compression (numbness, abnormal sensation in the extremities or both lower extremities, or even weakness or paralysis in both lower extremities), surgical treatment is required for decompression and debridement. If accompanied by spinal instability, surgical internal fixation is required. In general, it is difficult to diagnose spinal infections at an early stage of infection because the symptoms are not obvious. The possibility of spinal infection should be suspected when a fever develops but the cause of the fever cannot be identified, or when it is combined with severe back pain. If a spinal infection is delayed, it may cause spinal cord injury or even sepsis leading to death, in addition to unbearable back pain. Therefore, if you have a fever with increased back pain or an unexplained fever, don’t forget to visit a spine specialist to rule out this hidden killer – spinal infection.