Spinal osteomyelitis (SO) is a rare but serious infection of the vertebrae with occasional epidural involvement. Diagnosis is complicated by nonspecific findings that oftentimes mimic malignancy or tuberculosis, with typical methods of diagnosis such as blood culture and image-guided biopsy possessing varying levels of sensitivity. In this report, we present a rare case of SO that highlights these diagnostic difficulties. SO should be considered in a patient who presents with non-specific back pain. In such cases, non-diagnostic image-guided biopsy attempts do not rule out SO. Further investigations into additional diagnostic techniques to reduce false negatives are required to limit delays in diagnosis.