Management of Pyogenic Spondylodiscitis in Adults

High index of suspicion, MRI, multidisciplinary collaboration, and CT-guided biopsy are the cornerstones for an early diagnosis of infectious spondylodiscitis. The incidence of spondylodiscitis admissions is increasing. A notable proportion of patients present with neurological deficit. Unfortunately, IV drug users, frail and immunocompromised patients, and patients with HIV are most susceptible to have pyogenic spondylodiscitis and its complications. These infections have a mortality rate of up to 20%. Pyogenic spondylodiscitis should be managed with at least 6 weeks of IV antibiotics. It is best to involve an infectious disease specialist because of the wide variety of organisms involved and the emergence of resistance. Neurological deficits, instability, pain, deformity, and frailty are the factors that decide whether and when to perform surgery. Surgery can reduce morbidity, mortality, and length of hospital stay for these debilitating infections. Some studies have recommended stabilization without aggressive débridement, especially in frail patients. Implants (titanium and PEEK) as well as bone grafts (autograft and allograft) are safe in pyogenic spondylodiscitis. Minimally invasive spinal surgery reduces blood loss, surgical time, and hospital stay over classical open surgery. Endoscopic spine surgery is useful for debulking the infection and obtaining samples for diagnostic purposes.