Diagnosis and Treatment of Spondylodiscitis: Current Concepts

Abstract

Spondylodiscitis is infection of intervertebral discs and adjacent vertebral bodies with a variety of causes ranging from haematogenous spread or direct inoculation from interventional and surgical procedures. It is a rare disease with 3% mortality, and most clinicians have low exposure and find the management challenging. Our review aims to provide an evidence-based approach to inform readers of current concepts in the care of spinal infection. The commonest pathogen is staphylococcus aureus. Radiographs, blood cultures and biopsies yield high false-negative rates, leading to delays in diagnosis, and treatment challenges. Therefore, a high level of awareness is required to avoid mismanagement. We recommend a thorough checklist of investigations from the outset in order to avoid missed diagnosis of spondylodiscitis and associated conditions, and improve microbial yield. We also review available evidence on non-operative and surgical options, including emergency surgical intervention.