[Infectious spondylitis]

Nowadays, early diagnosis of spondylitis is possible. Technetium and gallium scintigrams are positive soon after the onset of the disease, while radiographs remain negative for weeks or even months. Blood and urine cultures and serologic tests may provide indications about the underlying infectious agent; however, needle biopsy establishes a precise bacteriologic diagnosis in up to 65% of the cases. Therefore, needle-biopsy is considered to be the most valuable diagnostic measure in spondylitis. Conservative treatment is indicated in cases of minimal destruction of the vertebral body. Surgery may be considered in cases of massive bone loss and kyphosis, and is strictly indicated in cases with spinal instability, abscess formation, and neurologic or septic complications, and when conservative treatment is ineffective.