Spondylodiscitis

Causes

Spondylodiscitis is the most common complication of sepsis or local infection, usually in the form of an abscess. The main causative organisms are staphylococci, but potential organisms include a large number of bacteria, fungi, zoonoses. Spondylodiscitis frequently develops in immunocompromised individuals, such as by a cancer, infection, or by immunosuppressive drugs used for organ transplantations.

Diagnosis

The main methods to diagnose a spondylodiscitis are magnetic resonance imaging (MRI), biopsy and microbiological tests such as PCR to determine an infectious cause. Positron emission tomography combined with computed tomography (PET/CT) has shown higher diagnostic accuracy (over 80%) than labeled leukocyte scintigraphy (about 50%) and is increasingly used alongside MRI in doubtful cases.

Treatment

Approximately 90% of cases can be treated conservatively. In the absence of spinal cord/nerve root compression and lack of data on instability of the inflamed segment, conservative treatment with:

• Antibiotics - empirical treatment should start AFTER biopsy material for microbiological testing is obtained (PMID 27082590). The following empirical treatment may be administered for a total of 6 weeks (PMID 26872859): - Ceftriaxone 2x2g and Clindamycin 3x600mg i.v. for 2 weeks - Ciprofloxacin 2x500mg and Clindamycin 4x300mg p.o. for 4 more weeks If the pathogen can be identified - antibiotic treatment should be adapted to the susceptibilities of the microorganism.
• Bed rest

References

References

1. (2007). "Pediatric Orthopedics in Practice". Springer.
2. Conti, Jacopo. (2025-09-29). "Infectious spondylodiscitis: Epidemiology, diagnosis, microbiological findings, clinical features and outcomes in a 14-year retrospective study". European Journal of Clinical Microbiology & Infectious Diseases.
3. (2008). "Spondylodiscitis". Bratislavske lekarske listy.
4. "SPONDYLODISCITIS".