Pyogenic spondylodiscitis : The quest towards a clinical-radiological classification

Area of Science:

• Orthopedics
• Neurosurgery
• Radiology

Background:

• Pyogenic spondylodiscitis (PS) is a severe spinal infection with significant orthopedic and neurological complications.
• Current management strategies are debated, leading to delayed treatment decisions.
• Existing classification systems for PS lack universal consensus.

Purpose of the Study:

• To critically review and appraise existing classification systems for pyogenic spondylodiscitis.
• To analyze the rationale and criteria used in various PS classification methods.
• To identify gaps and areas for improvement in PS classification.

Main Methods:

• A comprehensive literature search was performed using PubMed.
• Searches included various synonyms for spondylodiscitis and its classification.
• No restrictions were placed on publication language or date.

Main Results:

• A total of 43 relevant papers were identified, detailing 3 main classification systems.
• These systems, while overlapping, differ in their criteria.
• Key factors for classification include neurological deficits, abscess presence, spinal instability, lab results, and MRI findings.

Conclusions:

• Current PS classification systems incorporate clinically relevant factors but can be overly complex for practical use.
• Existing schemes may not adequately address specific conditions like cervical spine PS or certain types of vertebral slippage.
• Re-evaluation of classification criteria for validity and reliability, alongside recent guidelines, is necessary for standardized orthopedic management.