As a busy orthopaedic surgeon, I’ve pretty much seen it all when it comes to low back pain, and I’ve seen my share of emergency visits with patients who have severe low back pain along with a fever. In this article, I’m going to discuss the top five causes of low back pain with a fever and how they are treated, sometimes by me or by other health professionals.
- Infection – This is the number one cause of low back pain with a fever and can come from a variety of sources, some of which include:
- Kidney infection/stones/urinary tract infection – may cause horrific back pain with fever and is treated with antibiotics by PCP or at the ER – sometimes surgery or lithotripsy for kidney stones by Nephrologist
- Spinal epidural abscess – This is a true medical emergency and usually requires surgical drainage of the abscess. Oftentimes, there will be an accompanying structural issue that will need to be resolved as well with surgery, which could be from a previous surgery or could be a new issue, such as a herniated disc. Antibiotics will be prescribed and will be taken long term to prevent recurrence.
- Osteomyelitis is a painful infection of the bone and is a serious medical issue. I start treatment with 4-12 weeks of IV antibiotics, pain medication, wound therapy (if needed). If caught quickly enough, the infection may resolve. If not, surgery may be required to remove sections of the infected bone, drain pus and restore blood flow so that the bone can heal. Bracing may also be required to help the bone heal and to control painful movement.
- Inflammatory Conditions – These painful arthritic conditions which cause low back pain are different from infections and are caused by the body’s own immune response.
- Ankylosing Spondylitis – treated with steroids, biologic and DMARD medications by a Rheumatologist and by an Orthopaedist when surgery is necessary – typically fevers occur during a “flare” when disease activity is high
- Arthritis – treated with NSAIDs, with steroids, biologic and DMARD medications by an Orthopaedist typically fevers occur during a “flare” when disease activity is high
- Rheumatoid Arthritis – treated with steroids, biologic and DMARD medications by a Rheumatologist and by an Orthopaedist when surgery is necessary typically fevers occur during a “flare” when disease activity is high
- Sciatica – Many folks are unaware that fever can accompany sciatica, but usually the fever is a symptom of something else going on, like a mass, tumor or infection along with the sciatic nerve being inflamed. A fever with sciatica is definitely a red flag sign that you should head to see your orthopaedic physician immediately to get checked out. Diagnostic tests will be able to determine the cause of the fever and then appropriate steps can be taken by the surgeon to remedy the issue, whether that be antibiotics, a biopsy of a mass or surgery to drain an abscess.
- Pneumonia/Influenza/COVID – all of these can cause low back pain with fever and are treated with antiviral medications, steroids by PCP
- Endometriosis – This issue can cause low back pain with fever and is treated with Birth Control Pills and ablation procedures by a GYN physician – this only applies to ladies!