Which combination of clinical features is most supportive of spinal osteomyelitis?

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Spinal osteomyelitis typically presents with both systemic and local signs of infection. The combination of a recent infection, fever, and focal spinal tenderness points directly to an infectious process affecting the vertebrae or intervertebral discs, because you’d expect bacteremia or seeding to produce fever and a localized inflammatory response that produces tenderness over the involved level. Isolated radicular pain, while it can occur with nerve root irritation or other spine problems, isn’t specific for infection. Rapid improvement with NSAIDs would not be expected if an infection were driving the pain, since the underlying infection needs antibiotic treatment and often a longer course of therapy. Chronic back pain without fever lacks the acute inflammatory signals that raise suspicion for osteomyelitis. Together, the presence of recent infection, fever, and focal spinal tenderness aligns best with vertebral infection.