Spinal infections (SIs) are rare conditions affecting the intervertebral disc, vertebral body and/or adjacent spinal tissues. The lumbar region is most commonly involved, followed by the thoracic and cervical regions. Patients present with varied, non-specific clinical features leading to diagnostic and treatment delays. Clinicians need to have a low threshold to suspect SI. In this Element, two real-life cases of patients with SIs will be presented first. Core knowledge will be reviewed next, followed by diagnostic pitfalls and clinical pearls. Finally, the 'typical' clinical workflow for a patient with SI will be presented and the various treatment options will be explored.