This is an unusual case of systemic Staphylococcus aureus infection in a diabetic. Rather than originating in the disc or endplates (spondylodiscitis), infection is located centrally in the vertebral body as osteomyelitis, spreading bilaterally into the psoas muscles and posteriorly into the epidural space. This case highlights the sensitivity of MRI with IV Gad and the insensitivity of CT scanning for the diagnosis of spinal infection.